Provider Demographics
NPI:1851554836
Name:BONO, AMY G (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:BONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:325 OLD PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4493
Practice Address - Country:US
Practice Address - Phone:629-255-2099
Practice Address - Fax:629-255-4165
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46751207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525073Medicaid
TN103I111089Medicare PIN
TN10311I7066Medicare UPIN
621568119OtherMULTIPLAN
TN1525073Medicaid
TN1851554836OtherHEALTHSPRING
TN621568119OtherHUMANA
TN9868711OtherAETNA
TN621568119OtherUNITED HEALTHCARE
TN2281373OtherCOVENTRY
TN3440046OtherCIGNA
TN103I111089Medicare PIN