Provider Demographics
NPI:1336135946
Name:BENNETT, GARRETT N (MD)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:N
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N. CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3517
Mailing Address - Country:US
Mailing Address - Phone:229-758-3344
Mailing Address - Fax:229-758-6622
Practice Address - Street 1:208 N. CUTHBERT ST.
Practice Address - Street 2:MILLER COUNTY MEDICAL CENTER
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3517
Practice Address - Country:US
Practice Address - Phone:229-758-3344
Practice Address - Fax:229-758-6622
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA460811915BMedicaid
GA460811915AMedicaid
GA460811915BMedicaid
GA08BBQWDMedicare ID - Type Unspecified
GA460811915AMedicaid