NPI 1417127432

Jacob Eric Bentley, COLO

Practitioner Orthotist Hiram, GA

Practice location

Address: 127 Enterprise Path STE 403, Hiram, GA 30141-2697
Phone: (678) 384-1921
Fax: (678) 384-1922
Mailing address: 1619 John Orr Dr, Tifton, GA 31794-3640

Registered specialties

Orthotist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X Licence 14 (GA)

Other Orthotist providers in Georgia →

Registry record

NPI: 1417127432
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Mar 2008
Record last updated: 1 Jul 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.