Individual
ANTIONETTE AKIA BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8901 UNIVERSITY BLVD, N CHARLESTON, SC 29406-9116
(843) 203-2245
(843) 203-2244
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33166
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
331661
—
SC
Enumeration date
05/07/2008
Last updated
07/21/2022
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