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Individual

JASON BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LMSW

Contact information

Practice address
195 MILES ST, ATHENS, GA 30601-1820
(706) 389-6789
Mailing address
250 NORTH AVE, ATHENS, GA 30601-2244

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW005703
GA

Other

Enumeration date
07/03/2012
Last updated
07/03/2012
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