Brian R Bonfardin, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

22059 Issued in TN

Practice address

2306 Knob Creek Rd Ste 104
Johnson City, TN 37604-2366

Phone

(423) 794-7490

Fax

(423) 735-0289

NPI assigned

Nov 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• McKenzie Medical Center PC

  dba Hometown Health Clinic

  • Clinic/Center
  • McKenzie, TN
  • NPI 1700534229
  Medicare reassignment
• Camelot Care Centers, LLC

  dba Clarvida

  • Community/Behavioral Health Agency
  • Nashville, TN
  • NPI 1831397645
  NPD (past)
• East Tennessee Recovery, PLLC

  dba New Life Medicine

  • Addiction Medicine (Internal Medicine) Physician
  • Johnson City, TN
  • NPI 1114462215
  NPD (past)
• Takoma Hospital & Sanitarium Training School, Inc.

  dba Takoma Adventist Hospital

  • Psychiatric Hospital Unit
  • Greeneville, TN
  • NPI 1811915838
  NPD (past)

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786492800000",
    "number": "1356322515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD STE 104",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366",
            "telephone_number": "423-794-7490",
            "fax_number": "423-735-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD STE 104",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366",
            "telephone_number": "423-794-7490",
            "fax_number": "423-735-0289"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205A Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Mc Kenzie",
            "state": "TN",
            "postal_code": "382012024",
            "country_code": "US",
            "telephone_number": "731-352-7907",
            "fax_number": "833-690-3848",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 Takoma Ave",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377434647",
            "country_code": "US",
            "telephone_number": "423-639-3151",
            "fax_number": "423-798-1266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONFARDIN",
        "first_name": "BRIAN",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2026-08-12",
        "certification_date": "2026-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TN",
            "license": "22059",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BB2996140",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "22059",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriel Bolling, LCSW
• Lanny Clarice Bolling, PSY.D.
• Bolt Eye Group - Johnson City, LLC
• Katie Bolton
• Rhonda Jean Bolton, M.S. CCC-SLP
• Nicole Raastad Bonham, MA
• Bedford W. Bonta, MD
• Bethany Nicole Booher, FNP
• Samantha Bookbinder, MD
• Eric Bookout, MD

• Psychiatry Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Psychiatry Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.