Individual
JUSTIN BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-1896
(336) 716-5438
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
(336) 716-1896
(336) 716-5438
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2012-00983
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5921034
—
NC
Enumeration date
07/06/2009
Last updated
10/04/2012
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