Individual
DR. INDRANI BONGU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2806 HILLCREEK DR, AUGUSTA, GA 30909-6484
(706) 863-0200
(706) 863-4695
Mailing address
2806 HILLCREEK DR, AUGUSTA, GA 30909-6484
(706) 863-0200
(706) 863-4695
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
049418
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00888841B
—
GA
01
—
52820654
BCBS GA PROVIDER NUMBER
GA
01
—
G49418
SC MEDICAID
SC
Enumeration date
10/11/2006
Last updated
03/07/2023
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