Bonner, Mark W
Bonner, Mark W is an individual health care provider with primary practice located at 1157 Forsyth St , Macon GA 31201. He recently has 8 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Pharmacy Service Providers / Pharmacist, Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Bonner, Mark W can be contacted via phone (478) 745-8581.Contact Information
Primary practice address
1157 Forsyth St
Macon GA 31201
Phone: (478) 745-8581
Fax: (478) 328-0438
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / Dermatopathology | 207ND0900X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / Clinical & Laboratory Dermatological Immunology | 207NI0002X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | 057047 | Georgia |
| Pharmacy Service Providers / Pharmacist | 183500000X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | 057047 | Georgia |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 057047 | Georgia |
Profile Details
| NPI number | 1811961600 |
|---|---|
| LBN Legal business name | Bonner, Mark W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 16th, 2006 |
| Last updated | May 3rd, 2024 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811961600 | NPPES |
| Georgia | MEDICAID | 413577315A | |
| Georgia | Other | DC4061 | |
| Georgia | Other | P00258031 |
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