Provider Demographics
NPI:1841597861
Name:ABIDE, BONDA ANN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BONDA
Middle Name:ANN
Last Name:ABIDE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 AVON PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8305
Mailing Address - Country:US
Mailing Address - Phone:662-931-0490
Mailing Address - Fax:
Practice Address - Street 1:1120 AVON PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8305
Practice Address - Country:US
Practice Address - Phone:662-931-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS111662083P0901X
LAMD07203R2083P0901X
CAA461652083P0901X
HI79062083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine