Provider Demographics
NPI:1093757353
Name:BONDULICH, CLAUDIO SERGIO (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDIO
Middle Name:SERGIO
Last Name:BONDULICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 934915
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-4915
Mailing Address - Country:US
Mailing Address - Phone:404-501-7969
Mailing Address - Fax:404-501-3874
Practice Address - Street 1:3400 OLD MILTON PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-664-8898
Practice Address - Fax:770-772-4377
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23774207Q00000X
GA058730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI00945Medicare UPIN
GA503435530AMedicaid
GAI00945Medicare UPIN