Individual
BENNETT HASKIN TEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1301 CREEL ST, CONWAY, SC 29527-5018
(843) 248-4414
(843) 248-3781
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84208
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
842084
—
SC
Enumeration date
04/14/2020
Last updated
05/10/2024
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