JERRY L BENNETT (NPI# 1750382321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750382321 |
| Entity Type | Individual |
| Full Name | JERRY L BENNETT |
| Other Name | JERRY LEE BENNETT |
| Credential | MD |
| Practice Address |
2808 Maplewood Ave Winston Salem NC 27103-4138 |
| Practice Telephone | 3367659000 |
| Practice Fax Number | 3367655702 |
| Mailing Telephone | 3367659000 |
| Mailing Fax Number | 3367655702 |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | 15434 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA | AB3206542 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679636419 | Jerry Dell Bennett Jr. | Dentist | 305 University Dr, Suite 3, Valdosta, GA 31602-2626 | 2006-12-19 |
| 1699768119 | Jerry D Bennett | Specialist | 706 Legend Ln, Sherman, TX 75092-5421 | 2005-08-30 |
| Street Address |
2808 MAPLEWOOD AVE |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-4138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841852787 | Sara Elizabeth Absher Nagpal | Nurse Practitioner | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2019-07-01 |
| 1841798949 | Alexander Youth Network | Community/Behavioral Health | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2018-01-24 |
| 1245635184 | Molly Beal Toda | Nurse Practitioner | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2014-11-04 |
| 1154737898 | William Dustin Sellers | Physician Assistant | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2014-07-02 |
| 1154348597 | Highroad Pediatrics | Pediatrics | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2006-07-15 |
| 1326032947 | Tammie Frazier Wiley | Pediatrics | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2005-09-09 |
| 1720080674 | Peggy A Byun | Pediatrics | 2808 Maplewood Ave, Winston Salem, NC 27103-4138 | 2005-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609223601 | Ashmitha Raja | Pediatrics | Medical Centre Blvd, Winston Salem, NC 27157-0001 | 2016-05-19 |
| 1598128050 | Rebecca Palmer | Pediatrics | Brenner Childrens Hospital 300 Medical Blvd, Dept of Pediatrics, Winston Salem, NC 27157-0001 | 2016-04-01 |
| 1396131157 | Sarah Barnes Bingham | Pediatrics | One Medical Center Boulevard Emergency Medicine, Winston Salem, NC 27157 | 2015-04-08 |
| 1841685849 | Anna Hang Verenes | Pediatrics | Wake Forest Baptist Health Pediatrics, Medical Center Blvd, Winston Salem, NC 27157 | 2015-04-06 |
| 1568875227 | Kimberly Myers | Pediatrics | Wake Forest Baptist Medical, Medical Center Blvd, Winston Salem, NC 27157-0001 | 2014-06-10 |
| 1760700736 | Jennifer Mickle Cooper | Pediatrics | 2295 E 14th St Ste 100, Winston Salem, NC 27105-6804 | 2010-05-14 |
| 1215179700 | Cyndy Edwards Lively | Pediatrics | 1417 Brookstown Ave, Winston Salem, NC 27101-1126 | 2009-03-30 |
| 1205003274 | Bahar Emily Esmaili | Pediatrics | Wake Forest University Baptist Hospital, Medical Center Blvd, Winston Salem, NC 27157-0001 | 2008-05-09 |
| 1922274240 | Mdfamily Medical Group | Pediatrics | 138 S Cherry St, Winston Salem, NC 27101-5272 | 2008-05-06 |
| 1083714364 | Lia Simpson Erickson | Pediatrics | 648 East Monmouth Street, Winston Salem, NC 27107 | 2006-09-25 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.