| Doctor Name: | GRANT DOUGLAS BENNETT |
| NPI Number: | 1164691267 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2008500 |
| Business Practice Address: | 3351 Us Highway 84 Suite 102 Blackshear, GA - 315162100 |
| Business Phone Number: | 9128076625 |
| Business Fax Number: | 9128070212 |
| Mailing Address: | 6223 Clark Rd, BLACKSHEAR |
| State: | GA |
| Postal Code: | 315164043 |
| Phone Number: | 9128076625 |
| Fax Number: | 9128070212 |
| NPI Enumeration Date: | 02/22/2008 |
| NPI Last Update Date: | 05/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 2008500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |