Provider Demographics
NPI:1841801255
Name:BENNETT, NICHOLAS MCARTHUR
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:MCARTHUR
Last Name:BENNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1051
Mailing Address - Country:US
Mailing Address - Phone:240-234-9131
Mailing Address - Fax:
Practice Address - Street 1:419 BEASLEY DR APT T4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2875
Practice Address - Country:US
Practice Address - Phone:984-480-1783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle