Provider Demographics
NPI:1306090659
Name:BONTA, IOANA R (MD)
Entity type:Individual
Prefix:DR
First Name:IOANA
Middle Name:R
Last Name:BONTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:404-256-4777
Mailing Address - Fax:404-256-5515
Practice Address - Street 1:1100 JOHNSON FERRY RD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1739
Practice Address - Country:US
Practice Address - Phone:404-256-4777
Practice Address - Fax:404-256-5515
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052100207R00000X
GA063295207R00000X, 208M00000X
GA63295207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG12459AOtherMEDICARE PTAN
GA003158217EOtherMEDICAID
GA003158217DMedicaid