Individual
DR. BONZO K REDDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1107 E 66TH ST, SAVANNAH, GA 31404
(912) 350-8404
(912) 350-8067
Mailing address
1107 E 66TH ST, SAVANNAH, GA 31404-5701
(912) 350-8404
(912) 350-8067
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
072097
GA
207Q00000X
Family Medicine Physician
200401669
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003147505A
—
GA
01
—
2043636
MEDICARE
NC
05
—
5901642
—
NC
05
—
GA1657
—
SC
01
—
P01337521
RAILROAD MEDICARE
GA
Enumeration date
08/17/2006
Last updated
06/26/2018
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