MEDICARE: DR. RAY BURNETT BENNETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	056526	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841317138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAY BURNETT BENNETT M.D.

Provider Business Mailing Address
First Line	:	1325 COMMERCE DR STE 200
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3582
Country	:	US
Telephone Number	:	770-692-7575
Fax Number	:	770-692-7570

Provider Business Practice Location Address
First Line	:	1325 COMMERCE DR
Second Line	:	SUITE 200
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3582
Country	:	US
Telephone Number	:	770-692-7575
Fax Number	:	770-692-7570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	09/30/2025

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