Jacqueline Bennett, C.E.O

Primary specialty

Medical Laboratory TechnicianTaxonomy code 246RM2200X

License

9435480646JB Issued in GA

Practice address

1139 Hwy 54 E Lanier Ave Suite J
Fayetteville, GA 30215

Phone

(470) 302-7769

Fax

(888) 666-1770

NPI assigned

May 20, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1747699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1992597496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 N EXPRESSWAY UNIT 137",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302231746",
            "telephone_number": "404-934-2936",
            "fax_number": "888-666-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 HWY 54 E LANIER AVE SUITE J",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "30215",
            "telephone_number": "470-302-7769",
            "fax_number": "888-666-1770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "JACQUELINE",
        "credential": "C.E.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-20",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RM2200X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Medical Laboratory",
            "state": "GA",
            "license": "9435480646JB",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benchmark Physical Therapy, Inc
• Jonathan Christopher Bender, M.D.
• Benitaz Inc
• Benitaz Solutions Inc
• Denise Louise Bennett, MS, RD, LD, CDE
• Jeffrey Bennett, LPC
• Monica Renee Bennett, TRANSPORTATION
• Stephanie Bennette, NP
• Deborah Bentley, NP
• Stacey Bentley, RBT

• Medical Laboratory Technician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Medical Laboratory Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.