Provider Demographics
NPI:1093757353
Name:BONDULICH, CLAUDIO SERGIO (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIO
Middle Name:SERGIO
Last Name:BONDULICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 934915
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4915
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-3874
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:STE 601
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:404-501-2900
Practice Address - Fax:404-501-2992
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23774207Q00000X
GA058730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI00945Medicare UPIN
GA503435530AMedicaid
GAI00945Medicare UPIN