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NPI Code Detail

MEDICARE: JUDITH CECILE BENNETT M.D.

MEDICARE: JUDITH CECILE BENNETT M.D.
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
1208000000XPediatrics Physician033026GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215093547
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH CECILE BENNETT M.D.
Provider Business Mailing Address
First Line : 1600 FORT BENNING RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31903-2834
Country : US
Telephone Number : 706-322-9599
Fax Number : 706-689-4340
Provider Business Practice Location Address
First Line : 1600 FORT BENNING RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31903-2834
Country : US
Telephone Number : 706-322-9599
Fax Number : 706-689-4340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2006
Last Update Date : 05/05/2015

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