Healthcare Provider Details

I. General information

NPI: 1871505685
Provider Name (Legal Business Name): BRIAN BONNYMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10731 CHAPMAN HWY
SEYMOUR TN
37865-4765
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-0698
  • Fax: 865-573-3174
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number024276
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: