Individual
DIETRICE SWAIN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2743 JACANAR LN SW, ATLANTA, GA 30331-8012
(404) 625-3924
Mailing address
2743 JACANAR LN SW, ATLANTA, GA 30331-8012
(404) 625-3924
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
GA
Other
Enumeration date
06/30/2008
Last updated
06/30/2008
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