Individual
PATRISE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 957-3333
(601) 957-3334
Mailing address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 957-3333
(601) 957-3334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15488
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118967
—
MS
Enumeration date
07/24/2006
Last updated
07/08/2007
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