MEDICARE: DR. JAMES DANIEL BENNETT III 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	207W00000X	Ophthalmology Physician	12818	MS

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	:	1871596130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES DANIEL BENNETT III M.D.

Provider Business Mailing Address
First Line	:	2475 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2005
Country	:	US
Telephone Number	:	662-328-1254
Fax Number	:	662-327-2033

Provider Business Practice Location Address
First Line	:	2475 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2005
Country	:	US
Telephone Number	:	662-328-1254
Fax Number	:	662-327-2033

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/19/2008

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