Jack W. Bonner III, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

17455 Issued in SC

Practice address

701 Grove Rd
Greenville, SC 29605-5611

Phone

(864) 455-8431

NPI assigned

May 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Greenville Health System

  • General Acute Care Hospital
  • Simpsonville, SC
  • NPI 1558311779
  NPD (past)
• Greenville Health System

  • General Acute Care Hospital
  • Simpsonville, SC
  • NPI 1679992838
  NPD (past)
• Greenville Proaxis Therapy, LLC

  • Physical Therapist
  • Greenville, SC
  • NPI 1669457859
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261958400000",
    "number": "1336199751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 INDEPENDENCE PT",
            "address_2": "SUITE 140",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154566",
            "telephone_number": "864-797-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296055611",
            "telephone_number": "864-455-8431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNER",
        "first_name": "JACK",
        "middle_name": "W.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-10",
        "last_updated": "2009-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "SC",
            "license": "17455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174555",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Leigh Bond
• Sandra K Bond, RN
• Mark G Bone, CRNA
• Tamela Bonham, FNP-BC
• Samantha Boniface, MD
• William Pinckney Bonner, M.D.
• Emily Perez Bonnet, LPC
• Suzanne Elizabeth Boodle, RN
• Alexis Booker
• Kim Denise Booker, COTA/L

• Psychiatry Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Psychiatry Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.