Individual
JACQUELINE BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.E.O
Contact information
Practice address
1139 HWY 54 E LANIER AVE SUITE J, FAYETTEVILLE, GA 30215
(470) 302-7769
(888) 666-1770
Mailing address
1545 N EXPRESSWAY UNIT 137, GRIFFIN, GA 30223-1746
(404) 934-2936
(888) 666-1770
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
9435480646JB
GA
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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