Individual
DIANNE JEAN-MARIE BENNETT-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
483 INDIAN TRAIL LILBURN RD NW, LILBURN, GA 30047-3717
(770) 279-2427
(770) 279-0639
Mailing address
6050 PEACHTREE PKWY, SUITE 240-375, NORCROSS, GA 30092-3336
(770) 279-2427
(770) 279-0639
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
037957
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00630638F
—
GA
Enumeration date
10/16/2006
Last updated
07/08/2007
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