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LARRY G BENNETT PA
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1891893632
Individual Registrant: LARRY G BENNETT PA
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
92 BETTYS CREEK RD DILLARD, GA 30537-2257 US
Tel: 706-746-6571 Fax: 706-746-5643
Tel: 706-746-6571 Fax: 706-746-5643
Contact information for business:
PO BOX 444 DILLARD, GA 30537-0444 US
Tel: 706-746-6571 Fax: 706-746-5643
Tel: 706-746-6571 Fax: 706-746-5643
Registration Information:
NPI: 1891893632
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | GA | 000608 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 100000908C | GA | 05 |
