Provider Demographics
NPI:1245218338
Name:BENNETT, ANNA VIRGINIA (CNM)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:VIRGINIA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 US HIGHWAY 319 S
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-0565
Mailing Address - Country:US
Mailing Address - Phone:229-985-6738
Mailing Address - Fax:
Practice Address - Street 1:1243 US HIGHWAY 319 S
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-0565
Practice Address - Country:US
Practice Address - Phone:229-985-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144414367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0000975268AMedicaid