Individual
MARY W BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
101 HARRIS INDUSTRIAL BLVD, VIDALIA, GA 30474-8845
(912) 277-2035
Mailing address
707 LOOP RD, APT 2D, VIDALIA, GA 30474-8535
(912) 277-2035
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001249
GA
Other
Enumeration date
06/30/2006
Last updated
07/08/2007
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