Provider Demographics
NPI:1740064138
Name:BENNETT, HAYLEY KEIARA
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:KEIARA
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LANIER DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-8003
Mailing Address - Country:US
Mailing Address - Phone:478-983-1075
Mailing Address - Fax:
Practice Address - Street 1:13040 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1955
Practice Address - Country:US
Practice Address - Phone:912-478-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program