MARK W BONNER (NPI# 1811961600) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811961600 |
| Entity Type | Individual |
| Full Name | MARK W BONNER |
| Credential | MD |
| Practice Address |
1157 Forsyth St Macon GA 31201 |
| Mailing Address |
2400 Bellevue Rd Ste 21a Dublin GA 31021-2890 |
| Practice Telephone | 4787458581 |
| Practice Fax Number | 4783280438 |
| Mailing Telephone | 4782757202 |
| Mailing Fax Number | 4782748418 |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2015-04-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | 057047 | GA | Pharmacy Service Providers |
| Y | 207N00000X | Dermatology | 057047 | GA | Allopathic & Osteopathic Physicians |
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
057047 | GA | Allopathic & Osteopathic Physicians |
| N | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
057047 | GA | Allopathic & Osteopathic Physicians |
| N | 207NP0225X |
Dermatology Specialization: Pediatric Dermatology |
057047 | GA | Allopathic & Osteopathic Physicians |
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
057047 | GA | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | 057047 | GA | Allopathic & Osteopathic Physicians |
| N | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
057047 | GA | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | RAILROAD MEDICARE | P00258031 | 01 |
| GA | RAILROAD MEDICARE | DC4061 | 01 |
| GA | 413577315A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437188869 | Mark A Bonner | Family Medicine | 2630 E Citizens Dr Ste 13, Fayetteville, AR 72703-4797 | 2006-06-30 |
| Street Address |
1157 FORSYTH ST |
| City | MACON |
| State | GA |
| Zip Code | 31201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609869197 | Deborah D Moore | Physician Assistant | 1157 Forsyth St, Macon, GA 31201-7452 | 2005-08-30 |
| 1003952623 | In Stitches PC | Specialist | 1157 Forsyth St, Suite 200, Macon, GA 31201-7452 | 2007-01-30 |
| 1447363346 | Georgia Dermatology &skin Cancer Center, PC | Dermatology | 1157 Forsyth St, Macon, GA 31201-7452 | 2006-08-16 |
| 1831122357 | Lisa A Farmer | Specialist | 1157 Forsyth St, Suite 200, Macon, GA 31201-7452 | 2006-07-08 |
| 1043205388 | James B Lekas | Physician Assistant | 1157 Forsyth St, Macon, GA 31201-7452 | 2005-09-13 |
| 1811981368 | John A Broyles | Dermatology | 1157 Forsyth St, Macon, GA 31201-7452 | 2005-09-09 |
| 1487648648 | Myrtle Huntley Sanders | Physician Assistant | 1157 Forsyth St, Macon, GA 31201-7452 | 2005-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
| Find all providers in zip 31201 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558603969 | Bruce Stuart Allen | Dermatology | 1338 Old Forsyth Rd, Macon, GA 31210-7205 | 2013-03-24 |
| 1346351582 | Skin Care Physicians of Georgia, P.C. | Dermatology | 308 Coliseum Dr Ste 200, Macon, GA 31217-3861 | 2006-08-31 |
| 1073501276 | Virginia Childs Hall | Dermatology | 520 Charter Blvd, Suite 100, Macon, GA 31210-4871 | 2005-10-11 |
| 1194722850 | David E Kent | Dermatology | 308 Coliseum Dr, Suite 200, Macon, GA 31217-3876 | 2005-07-07 |
| 1114296464 | Billie L. Jackson, M.d., LLC | Dermatology | 440 Charter Blvd, Suite 2201, Macon, GA 31210-0724 | 2011-12-15 |
| 1962739417 | Allen Dermatology & Skincancer Center LLC | Dermatology | 520 Charter Blvd, Suite 100, Macon, GA 31210-4871 | 2009-11-04 |
| 1124288790 | Judah Norman Greenberg | Dermatology | 308 Coliseum Dr Ste 200, Macon, GA 31217-3861 | 2008-06-16 |
| 1922160811 | Jennifer Hawkins Allen | Dermatology | 520 Charter Blvd, Suite 100, Macon, GA 31210-4871 | 2006-12-15 |
| 1235232430 | Billie Luke Jackson | Dermatology | 440 Charter Blvd, Suite 2201, Macon, GA 31210-4857 | 2006-09-06 |
| 1447363346 | Georgia Dermatology &skin Cancer Center, PC | Dermatology | 1157 Forsyth St, Macon, GA 31201-7452 | 2006-08-16 |
| Find all providers in MACON | ||||
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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.