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General NPI Number Information
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NPI Number | 1114990009
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Entity Type | Individual
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Provider Name | GARRISON S. BENNETT MD
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 15769 WC MAIN ST
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-7327
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Country | US
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Telephone | 804-419-9760
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Fax | 804-378-9140
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Provider Business Mailing Address
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Address Line | 3000 WATERCOVE RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112
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Country | US
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Telephone | 804-744-8140
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Fax | 804-744-7390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101102655
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101-102655
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License Number State | VA
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