Active NPI
Joan Karen Bennett, LMT, MMP
- Specialist
- Roswell, GA
National Provider Identifier
1205084308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MT000957
- Practice address
- 2500 Old Alabama Rd
Suite 24
Roswell, GA 30076-2400 - Phone
- (770) 998-9009
- Fax
- (770) 998-9701
- NPI assigned
- Sep 3, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MT000957 | GA | Primary |
Addresses
Primary practice location
2500 Old Alabama Rd
Suite 24
Roswell, GA 30076-2400
Mailing address
2500 Old Alabama Road
Suite 24
Roswell, GA 30076-2400
Phone (770) 998-9009
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MT000957 | Other | GA | MASSAGE THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT000957 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1220400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1205084308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 OLD ALABAMA ROAD",
"address_2": "SUITE 24",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300762400",
"telephone_number": "770-998-9009",
"fax_number": "770-998-9071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 OLD ALABAMA RD",
"address_2": "SUITE 24",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300762400",
"telephone_number": "770-998-9009",
"fax_number": "770-998-9701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "JOAN",
"middle_name": "KAREN",
"name_prefix": "Mrs.",
"credential": "LMT, MMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-09-03",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "MT000957",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPY",
"identifier": "MT000957",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.