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General NPI Number Information
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NPI Number | 1689182784
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Entity Type | Individual
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Provider Name | KRISTIN LEIGH BENNETT NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 01/11/2018
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Provider Practice Location Address
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Address Line | 2000 RIVERSIDE PKWY STE 107
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5926
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Country | US
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Telephone | 770-881-3638
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Fax |
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Provider Business Mailing Address
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Address Line | 470 OLD HENRY GRADY RD
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City | DAWSONVILLE
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State | GA
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Zip | 30534-2424
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Country | US
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Telephone | 706-216-7055
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN184042
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License Number State | GA
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