Jack W. Bonner III, M.D.
Psychiatry & Neurology, Psychiatry in Greenville, SC. Individual provider (NPI-1).
NPI number1336199751
StatusActive
Last updated in NPPESDec 28, 2009
Details
- NPI
- 1336199751
- Entity type
- Individual (NPI-1)
- Name
- Jack W. Bonner III
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 10, 2006
- Last updated
- Dec 28, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | 17455 | SC | Yes |
Practice location
701 Grove RdGreenville, SC 29605-5611
Phone 864-455-8431
Mailing address
7 Independence PtSuite 140
Greenville, SC 29615-4566
Phone 864-797-6044
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