Provider Demographics
NPI:1336102425
Name:BOGNAR, MARTA T (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:T
Last Name:BOGNAR
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LANE NE
Mailing Address - Street 2:STE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:770-531-3718
Practice Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LN NE
Practice Address - Street 2:STE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2418
Practice Address - Country:US
Practice Address - Phone:770-531-3711
Practice Address - Fax:770-531-3718
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2022-09-13
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Provider Licenses
StateLicense IDTaxonomies
GA040320207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753849DMedicaid
GADC9903OtherRR MEDICARE
GA66BBBHFMedicare PIN
G5591Medicare UPIN