Provider Demographics
NPI:1699342279
Name:BENNETT, JA'MIRACLE CHAMBRAY
Entity type:Individual
Prefix:
First Name:JA'MIRACLE
Middle Name:CHAMBRAY
Last Name:BENNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-2399
Mailing Address - Country:US
Mailing Address - Phone:706-347-2074
Mailing Address - Fax:
Practice Address - Street 1:250 BRAY ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2203
Practice Address - Country:US
Practice Address - Phone:706-389-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker