Provider Demographics
NPI:1912751751
Name:BENNETT, MONICA RENEE (TRANSPORTATION)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:BENNETT
Suffix:
Gender:F
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 COMMERCE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7352
Mailing Address - Country:US
Mailing Address - Phone:678-545-2361
Mailing Address - Fax:
Practice Address - Street 1:105 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7352
Practice Address - Country:US
Practice Address - Phone:678-545-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver