Healthcare Provider Details

I. General information

NPI: 1356778112
Provider Name (Legal Business Name): JANET M DENTON-BENNETT CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 ATKINSON RD
LAWRENCEVILLE GA
30043-5003
US

IV. Provider business mailing address

4826 CLARKSTONE DR
FLOWERY BRANCH GA
30542-3326
US

V. Phone/Fax

Practice location:
  • Phone: 470-577-0718
  • Fax:
Mailing address:
  • Phone: 470-577-0718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAP9766
License Number StateVI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN248759
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: