Deundray Bentley, BS
Individual provider Active NPI Contractor · Macon, GA
NPI 1104262989 · NPPES record last updated May 20, 2013
Key facts
- NPI
- 1104262989
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 6601 Zebulon Rd
Macon, GA 31220-7606 - Phone
- (478) 477-3383
- Fax
- (478) 957-9492
- NPI assigned
- May 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hephzibah Childrens Home | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
6601 Zebulon Rd
Macon, GA 31220-7606
Mailing address
2714 Montpelier Ave
Macon, GA 31204-5228
Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.