Basic Information
| Provider Information | |||||||||
| NPI: | 1639372147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOMELI | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 JOHNSON FY RD NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049430900 | ||||||||
| FaxNumber: | 4049431390 | ||||||||
| Practice Location | |||||||||
| Address1: | 960 JOHNSON FY RD NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049430900 | ||||||||
| FaxNumber: | 4049431390 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 12/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 071097 | GA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | P01027663 | 01 | MEDICARE RAILROAD | OTHER | 5917792 | 05 | NC | MEDICAID | 1629781 | 01 | NC | CIGNA | OTHER | 071097 | 01 | GA | GA LICENSE | OTHER | 164XK | 01 | NC | BCBSNC | OTHER | 30099942 | 01 | SC | SELECT HEALTH OF SC | OTHER | 9219664 | 01 | NC | AETNA | OTHER | NC1403 | 05 | SC | MEDICAID |