Healthcare Provider Details

I. General information

NPI: 1053016022
Provider Name (Legal Business Name): BRADEN CHASE BENNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3981 HIGHWAY 9
BOILING SPRINGS SC
29316-8578
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-978-9841
  • Fax:
Mailing address:
  • Phone: 864-560-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89951
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: