Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIRO10232 | GA |
NPI | 1003447418 |
---|---|
Provider Name | Dr. Nathan Bennett |
First Address | Dallas, GA 30132-0348 |
Second Address | Marietta, GA 30064-1096 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2020 |
Last Update Date | 04/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NOT IN ANY INSURANCE NETWORKS (01) |