Provider Demographics
NPI:1427353580
Name:BENNETT MOBILITY PRODUCTS LLC
Entity type:Organization
Organization Name:BENNETT MOBILITY PRODUCTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER/SINGLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:D
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-807-6625
Mailing Address - Street 1:638 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1208
Mailing Address - Country:US
Mailing Address - Phone:912-807-6625
Mailing Address - Fax:912-807-0212
Practice Address - Street 1:638 GORDON ST
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1208
Practice Address - Country:US
Practice Address - Phone:912-807-6625
Practice Address - Fax:912-807-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2010000805332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA879144878AMedicaid
GA003108583AMedicaid
GA003108583AMedicaid
GA6525670001Medicare NSC