Provider Demographics
NPI:1952410730
Name:BENNETT, HELEN H (PA)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:H
Last Name:BENNETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:HUMPHRIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4285 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6038
Mailing Address - Country:US
Mailing Address - Phone:770-622-4412
Mailing Address - Fax:770-622-4191
Practice Address - Street 1:1951 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3415
Practice Address - Country:US
Practice Address - Phone:404-321-4600
Practice Address - Fax:404-320-0987
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003437363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA789094798AMedicaid
GA789094798AMedicaid
97WCGGNMedicare ID - Type Unspecified