Provider Demographics
NPI:1700239720
Name:BONIN, ELIZABETH PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:BONIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ASHLEY
Other - Last Name:PAIGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5501 ABERCORN ST STE D
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6915
Mailing Address - Country:US
Mailing Address - Phone:912-232-9700
Mailing Address - Fax:912-748-0270
Practice Address - Street 1:5356 REYNOLDS ST STE 201
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6019
Practice Address - Country:US
Practice Address - Phone:912-232-9700
Practice Address - Fax:912-748-0270
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical