Provider Demographics
NPI:1679742555
Name:BENNETT, JAMES R JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:BENNETT
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:5220 OLEANDER DR FL 2
Mailing Address - Street 2:ATTN: CRENDENTIALING
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7021
Mailing Address - Country:US
Mailing Address - Phone:910-395-8333
Mailing Address - Fax:910-395-8473
Practice Address - Street 1:5220 OLEANDER DR FL 2
Practice Address - Street 2:ATTN: CRENDENTIALING
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7021
Practice Address - Country:US
Practice Address - Phone:910-395-8333
Practice Address - Fax:910-395-8473
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2017-01-26
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant