MEDICARE: DR MARTA BOGNAR PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	040320	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598873754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR MARTA BOGNAR PC

Provider Business Mailing Address
First Line	:	961 SMOKY MOUNTAIN SPRINGS LANE NE
Second Line	:	SUITE A
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2439
Country	:	US
Telephone Number	:	770-531-3711
Fax Number	:	770-531-3718

Provider Business Practice Location Address
First Line	:	961 SMOKY MOUNTAIN SPRINGS LANE NE
Second Line	:	SUITE A
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-2439
Country	:	US
Telephone Number	:	770-531-3711
Fax Number	:	770-531-3718

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARTA T BOGNAR
Credential	:	M.D.
Telephone Number	:	770-531-3711

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	02/05/2008

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