Individual
DR. RAQUEL LISA BENNETT- GITTENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 322-7884
(706) 660-2118
Mailing address
2300 MANCHESTER EXPY STE 2001A, COLUMBUS, GA 31904-6802
(706) 320-3126
(706) 320-3054
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
70713
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140208B
—
GA
01
—
202I061193
MEDICARE PTAN
GA
Enumeration date
04/14/2008
Last updated
07/29/2024
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