Provider Demographics
NPI:1700919404
Name:BUNCE, ANTONIA REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIA
Middle Name:REBECCA
Last Name:BUNCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 JOHNSON FERRY RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-497-1020
Mailing Address - Fax:404-252-1530
Practice Address - Street 1:875 JOHNSON FERRY RD
Practice Address - Street 2:STE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-497-1020
Practice Address - Fax:404-252-1530
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA941298354BMedicaid
GA941298354DMedicaid
GA941298354AMedicaid
GA941298354CMedicaid
GA941298354BMedicaid
GA941298354DMedicaid
GAH61887Medicare UPIN