Individual
JACOB ALAN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 COURTENAY DR STE 4200, CHARLESTON, SC 29425-4001
(843) 876-5744
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
28580
SC
Other
Enumeration date
08/28/2023
Last updated
05/08/2024
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