Individual
GARRISON S. BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15769 WC MAIN ST, MIDLOTHIAN, VA 23113-7327
(804) 419-9760
(804) 378-9140
Mailing address
3000 WATERCOVE RD, MIDLOTHIAN, VA 23112
(804) 744-8140
(804) 744-7390
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101102655
VA
207Q00000X
Family Medicine Physician
Primary
0101-102655
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10002698
OPTIMA
VA
05
—
1114990009
—
VA
01
—
3071733
CIGNA
VA
01
—
308372
ANTHEM
VA
01
—
5163353
UNITED HEALTHCARE
VA
01
—
540883363
GREAT WEST
VA
01
—
7076211
AETNA
VA
01
—
726824
SOUTHERN HEALTH
VA
Enumeration date
02/10/2006
Last updated
07/25/2013
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