Provider Demographics
NPI:1811192735
Name:DOSTER, BUNNY (PC-C)
Entity Type:Individual
Prefix:
First Name:BUNNY
Middle Name:
Last Name:DOSTER
Suffix:
Gender:F
Credentials:PC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 SANDERS RD
Mailing Address - Street 2:STE B
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5977
Mailing Address - Country:US
Mailing Address - Phone:770-781-8840
Mailing Address - Fax:770-781-8098
Practice Address - Street 1:980 SANDERS RD
Practice Address - Street 2:STE B
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5977
Practice Address - Country:US
Practice Address - Phone:770-781-8840
Practice Address - Fax:770-781-8098
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004107363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003141545CMedicaid
GA2029I72307Medicare PIN
GAQ55972Medicare UPIN