Individual
JUANITA BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3722 WALTON WAY EXT, AUGUSTA, GA 30907-2436
(478) 305-9466
Mailing address
3722 WALTON WAY EXT, AUGUSTA, GA 30907-2436
(478) 305-9466
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
09/13/2019
Last updated
09/13/2019
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