Basic Information
| Provider Information | |||||||||
| NPI: | 1306090659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONTA | ||||||||
| FirstName: | IOANA | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042564777 | ||||||||
| FaxNumber: | 4042565515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 JOHNSON FERRY RD STE 600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042564777 | ||||||||
| FaxNumber: | 4042565515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2008 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125052100 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 063295 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 063295 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RH0003X | 63295 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | G12459A | 01 | GA | MEDICARE PTAN | OTHER | 003158217E | 01 | GA | MEDICAID | OTHER | 003158217D | 05 | GA | MEDICAID |