Individual
GRANT DOUGLAS BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3351 US HIGHWAY 84, SUITE 102, BLACKSHEAR, GA 31516-2100
(912) 807-6625
(912) 807-0212
Mailing address
6223 CLARK RD, BLACKSHEAR, GA 31516-4043
(912) 807-6625
(912) 807-0212
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2008500
GA
Other
Enumeration date
02/22/2008
Last updated
05/16/2008
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