Provider Demographics
NPI:1518187277
Name:HANSON, BONNIE VANSCHOONEVELD (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:VANSCHOONEVELD
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1313
Mailing Address - Country:US
Mailing Address - Phone:229-245-0447
Mailing Address - Fax:229-245-0448
Practice Address - Street 1:2001 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2944
Practice Address - Country:US
Practice Address - Phone:229-245-0447
Practice Address - Fax:229-245-0448
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00707539CMedicaid
GAE37057Medicare UPIN