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Individual

DR. GARY ROY BODNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5515 POWERS RIDGE CT, ATLANTA, GA 30327-4295
(770) 952-4945
(770) 952-0320
Mailing address
5515 POWERS RIDGE CT, ATLANTA, GA 30327-4295
(770) 952-4945
(770) 952-0320

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
18205
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000117686F
GA
05
000117686G
GA
05
000117686L
GA
Enumeration date
09/27/2005
Last updated
10/04/2017
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