Provider Demographics
NPI:1952355455
Name:BONK, CATHERINE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:MARY
Last Name:BONK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WINN WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2111
Mailing Address - Country:US
Mailing Address - Phone:404-299-9724
Mailing Address - Fax:404-299-0382
Practice Address - Street 1:315 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2111
Practice Address - Country:US
Practice Address - Phone:404-299-9724
Practice Address - Fax:404-299-0382
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030435207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0700305OtherUNITED HEALTHCARE
GA000433617GMedicaid
GA000433617BMedicaid
GA618191OtherBLUE CROSS BLUE SHIELD
GA16BDSSRMedicare ID - Type Unspecified
GA000433617BMedicaid
GA000433617GMedicaid