Individual
BRYAN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
500 CHERRY ST, BLUEFIELD, WV 24701-3306
(304) 327-1656
Mailing address
5665 NEW NORTHSIDE DR STE 320, ATLANTA, GA 30328-5834
(770) 874-6854
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-119291
AL
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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