Healthcare Provider Details

I. General information

NPI: 1114857166
Provider Name (Legal Business Name): ALLISON BRYNN BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 WHALEY RD
JESUP GA
31546-2330
US

IV. Provider business mailing address

1382 WHALEY RD
JESUP GA
31546-2330
US

V. Phone/Fax

Practice location:
  • Phone: 912-217-4752
  • Fax:
Mailing address:
  • Phone: 912-217-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC010120
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: