Individual
AMANDA BLANCHE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8004 MYRTLE TRACE DR STE 200, CONWAY, SC 29526-8945
(843) 347-8041
(843) 347-8042
Mailing address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5901
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8123PA
—
SC
Enumeration date
12/30/2015
Last updated
09/04/2025
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