Provider Demographics
NPI:1679663785
Name:BENNETT, JULIAN A (MD)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:A
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 1:1010 KYLE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-4534
Mailing Address - Country:US
Mailing Address - Phone:615-852-7725
Mailing Address - Fax:
Practice Address - Street 1:1010 KYLE LN
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-4534
Practice Address - Country:US
Practice Address - Phone:615-852-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080506B207P00000X
TNMD0000042284207R00000X
TNMD42284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2426566Medicaid
TN4160664OtherBCBS
TN3000938Medicaid
TN3283015Medicaid
3283015Medicare PIN
TN3283015Medicaid
TN4160664OtherBCBS