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Individual

BRIAN NATHAN BENNETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
1416 WAINBROOK DR, AUGUSTA, GA 30909-6289
(706) 312-3668
(706) 312-3670
Mailing address
1416 WAINBROOK DR, AUGUSTA, GA 30909-6289
(706) 312-3668
(706) 312-3670

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000842
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000812985C
GA
05
00812985B
GA
01
2592457
AETNA HMO
GA
01
2700070
UNITED HEALTHCARE
GA
01
4292280003
MEDICARE PTAN
GA
01
480032159
RAILROAD MEDICARE
GA
01
7052274
BCBS OF GEORGIA
GA
01
7104253
AETNA PPO
GA
01
GPD842
SOUTH CAROLINA MEDICAID
SC
Enumeration date
09/15/2006
Last updated
06/17/2019
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