| Doctor Name: | CASEY JO BENNETT |
| NPI Number: | 1144680034 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | RN188746 |
| Business Practice Address: | 1948 Old Ocilla Rd Tifton, GA - 317941644 |
| Business Phone Number: | 2293913500 |
| Business Fax Number: | |
| Mailing Address: | 1948 Old Ocilla Rd, TIFTON |
| State: | GA |
| Postal Code: | 31794 |
| Phone Number: | 2293913500 |
| Fax Number: | |
| NPI Enumeration Date: | 03/04/2016 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LX0001X |
| License Number: | RN188746 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Obstetrics & Gynecology |
| Taxonomy Definition: | |