Healthcare Provider Details

I. General information

NPI: 1215934872
Provider Name (Legal Business Name): BONNERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 05/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GILMER AVE
TALLASSEE AL
36078-1209
US

IV. Provider business mailing address

207 GILMER AVE
TALLASSEE AL
36078-1209
US

V. Phone/Fax

Practice location:
  • Phone: 334-283-5625
  • Fax: 334-283-5809
Mailing address:
  • Phone: 334-283-5625
  • Fax: 334-283-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number260018275
License Number StateAL

VIII. Authorized Official

Name: JOHN BRADLEY BONNER
Title or Position: VICE PRESIDENT
Credential:
Phone: 334-283-5625