Provider Demographics
NPI:1598873754
Name:DR MARTA BOGNAR PC
Entity Type:Organization
Organization Name:DR MARTA BOGNAR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOGNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-531-3711
Mailing Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LANE NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2439
Mailing Address - Country:US
Mailing Address - Phone:770-531-3711
Mailing Address - Fax:770-531-3718
Practice Address - Street 1:961 SMOKY MOUNTAIN SPRINGS LANE NE
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2439
Practice Address - Country:US
Practice Address - Phone:770-531-3711
Practice Address - Fax:770-531-3718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040320207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753849DMedicaid
GAGRP6957Medicare PIN
GA00753849DMedicaid