Individual
CHASE GREGORY BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
152 E KINDERTON WAY STE 101, ADVANCE, NC 27006
(704) 384-7834
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(703) 405-8881
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
077544
GA
207X00000X
Orthopaedic Surgery Physician
Primary
2018-01423
NC
207XS0117X
Orthopaedic Surgery of the Spine Physician
077544
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
077544
GEORGIA COMPOSITE MEDICAL BOARD
GA
Enumeration date
04/05/2012
Last updated
10/20/2021
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