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LARRY G BENNETT PA

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1891893632

Individual Registrant:
 LARRY G BENNETT PA
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

Contact information for business:
PO BOX 444  DILLARD, GA 30537-0444 US
Tel: 706-746-6571  Fax: 706-746-5643

Registration Information:
NPI: 1891893632
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
GA000608

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
100000908CGA05




HEALTH CARE JOBS GA - Page 1



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