Doctor Name: | BERNARD LEROY BENNETT |
NPI Number: | 1871568899 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 36493 |
Business Practice Address: | 4220 Apex Hwy Ste 130 Durham, NC - 277135295 |
Business Phone Number: | 9195444747 |
Business Fax Number: | 9195440104 |
Mailing Address: | Po Box 281634, ATLANTA |
State: | GA |
Postal Code: | 303841634 |
Phone Number: | 9195444747 |
Fax Number: | 9195440104 |
NPI Enumeration Date: | 02/22/2006 |
NPI Last Update Date: | 07/13/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 36493 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |