Amy Elizabeth Bennett, DC
Individual provider Active NPI Chiropractor · Dacula, GA
NPI 1821556986 · NPPES record last updated Mar 7, 2019
Key facts
- NPI
- 1821556986
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIRO10164 (GA)
- Practice address
- 3613 Braselton Hwy Ste 101
Dacula, GA 30019-4665 - Phone
- (678) 482-2014
- NPI assigned
- Mar 7, 2019
- Sex
- Female
- Sole proprietor
- No
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)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CHIRO10164 | GA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Terry D. Southerland, D.C.P.C. | Chiropractor | Current |
Accepting new patients |
Locations
3613 Braselton Hwy
Ste 101
Dacula, GA 30019
Phone (678) 482-2014
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CHIRO10164 | GA | Yes |
Addresses
Primary practice location
3613 Braselton Hwy Ste 101
Dacula, GA 30019-4665
Mailing address
160 Prestwyck Oak PL
Lawrenceville, GA 30043-2962
Phone (706) 206-8094
Other providers in Dacula, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2019. 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.