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General NPI Number Information
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NPI Number | 1255192944
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Entity Type | Individual
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Provider Name | SAMUEL BENNETT CNP
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Gender | Male
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1305 JENNINGS MILL RD STE 260
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7307
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Country | US
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Telephone | 706-548-0008
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Fax | 706-369-9673
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Provider Business Mailing Address
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Address Line | 340 N MILLEDGE AVE STE B
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City | ATHENS
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State | GA
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Zip | 30601-3806
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Country | US
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Telephone | 706-548-0008
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Fax | 706-369-9673
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN-NP296584
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License Number State | GA
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