Individual
MICHAEL BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 W BROAD AVE, ALBANY, GA 31707-4397
(220) 430-3138
Mailing address
422 VINTAGE RD, ALBANY, GA 31705-3413
(229) 439-0399
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN153003
GA
Other
Enumeration date
12/03/2013
Last updated
12/04/2013
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