Basic Information
| Provider Information | |||||||||
| NPI: | 1285984005 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONETTI LUGO | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | HILDA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D, | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BONETTI | ||||||||
| OtherFirstName: | ANA | ||||||||
| OtherMiddleName: | HILDA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 405827 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303845827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012263186 | ||||||||
| FaxNumber: | 9012273206 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 BAPTIST BLVD STE 402 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397052006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622442550 | ||||||||
| FaxNumber: | 6622442553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 25447 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.