Individual
DR. BONAMICO PORTER JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
ORTHOPAEDIC SURGERY RESIDENCY PROGRAM, DDEAMC, 300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
(706) 787-1647
Mailing address
300 EAST HOSPITAL ROAD, FORT GORDON, GA 30905-5650
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
94708
GA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/27/2021
Last updated
02/21/2023
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