Individual
EMILY GRACE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
971 LAKELAND DR STE 250, JACKSON, MS 39216-4620
(662) 803-5763
Mailing address
800 WESTERLY DR, BRANDON, MS 39042-9578
(601) 941-3545
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
PA-00809
MS
Other
Enumeration date
06/24/2024
Last updated
06/24/2024
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