Provider Demographics
NPI:1184399057
Name:BENNETT, ERIN PAIGE (BS)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:PAIGE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JONES AVE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-2040
Mailing Address - Country:US
Mailing Address - Phone:762-204-7603
Mailing Address - Fax:
Practice Address - Street 1:137 N ERWIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3123
Practice Address - Country:US
Practice Address - Phone:770-334-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor