Bonner, Jack W.

Bonner, Jack W. is an individual health care provider with primary practice located at 701 Grove Rd , Greenville SC 29605-5611. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Bonner, Jack W. can be contacted via phone (864) 455-8431.

Contact Information

Primary practice address
701 Grove Rd Greenville SC 29605-5611
Phone: (864) 455-8431
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 17455 South Carolina

Profile Details

NPI number 1336199751
LBN Legal business name Bonner, Jack W.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2006
Last updated Dec 28th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336199751 NPPES
South Carolina MEDICAID 174555

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