Provider Demographics
NPI:1609038207
Name:BONNAIG, NICOLAS SIMON (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:SIMON
Last Name:BONNAIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 TOWER RD NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9404
Mailing Address - Country:US
Mailing Address - Phone:770-427-5717
Mailing Address - Fax:770-514-5040
Practice Address - Street 1:300 TOWER RD NE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-9404
Practice Address - Country:US
Practice Address - Phone:770-427-5717
Practice Address - Fax:770-514-5040
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2014-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA071318207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I203699Medicare PIN