Healthcare Provider Details

I. General information

NPI: 1194007708
Provider Name (Legal Business Name): BONNIE L DOERR REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 MARTIN LOOP
FORT BENNING GA
31905-5648
US

IV. Provider business mailing address

7950 MARTIN LOOP
FORT BENNING GA
31905-5648
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-1442
  • Fax:
Mailing address:
  • Phone: 706-544-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT81815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: