Individual
IRA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
419 N WALL ST, CALHOUN, GA 30701-1943
(706) 659-7664
Mailing address
1503 N TIBBS RD, DALTON, GA 30720-2915
(706) 270-5033
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006599
GA
Other
Enumeration date
12/31/2020
Last updated
12/31/2020
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