Provider Demographics
NPI:1821753344
Name:BONHAM LLC
Entity Type:Organization
Organization Name:BONHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-291-1455
Mailing Address - Street 1:130 INVERNESS PLZ # 185
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4800
Mailing Address - Country:US
Mailing Address - Phone:205-259-8223
Mailing Address - Fax:
Practice Address - Street 1:130 INVERNESS PLZ # 185
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4800
Practice Address - Country:US
Practice Address - Phone:205-259-8223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty