Provider Demographics
NPI:1316998982
Name:BONNEY, LOIDA E (MD)
Entity type:Individual
Prefix:DR
First Name:LOIDA
Middle Name:E
Last Name:BONNEY
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 1:1267 HIGHWAY 54 W
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2114
Mailing Address - Country:US
Mailing Address - Phone:770-719-5601
Mailing Address - Fax:678-817-4361
Practice Address - Street 1:745 GLYNN ST S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2049
Practice Address - Country:US
Practice Address - Phone:770-719-5490
Practice Address - Fax:770-719-3113
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59375207R00000X, 207R00000X
RIMD11834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI43058Medicare UPIN
RII43058Medicare UPIN