Individual
REGGIE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-2000
Mailing address
4616 TUTEN DR, BRISTOL, GA 31518-3206
(912) 424-0538
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
789789989
GA
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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