MEDICARE: JOHN CHARLES BENNETT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	057581	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	057581	OTHER	GA	STATE MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164470761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN CHARLES BENNETT MD

Provider Business Mailing Address
First Line	:	500 W 3RD AVE
Second Line	:	SUITE 101
City	:	ALBANY
State	:	GA
Zip	:	31701-1985
Country	:	US
Telephone Number	:	229-312-5839
Fax Number	:	229-312-5853

Provider Business Practice Location Address
First Line	:	425 W 3RD AVE
Second Line	:	SUITE 410
City	:	ALBANY
State	:	GA
Zip	:	31701-1941
Country	:	US
Telephone Number	:	229-312-0707
Fax Number	:	229-312-0705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	02/08/2017

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