Provider Demographics
NPI:1821045568
Name:DUNHAM, BONNIE C (RD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:C
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6000
Mailing Address - Fax:423-433-6140
Practice Address - Street 1:325 N STATE OF FRANKLIN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6062
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:423-439-8110
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN781133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81064Medicare UPIN
TN3240692Medicare ID - Type Unspecified