Stephen Joseph Bonanni Jr., PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12279 Issued in GA

Practice address

508 N Main St Ste a
Hinesville, GA 31313-2570

Phone

(912) 785-2100

Fax

(912) 368-3868

NPI assigned

Nov 27, 2013

Reactivated

May 9, 2025

Last updated

Sep 16, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Privia Medical Group of Georgia LLCGroup PAC ID 4284951542, 454 clinicians

Horizon Behavioral Health, P.C.Group PAC ID 6204016611, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stephen.bonanni.1@8042.direct.athenahealth.com

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

• Horizon Behavioral Health, P.C.

  • Psychiatry Physician
  • Hinesville, GA
  • NPI 1891003299
  Medicare reassignment Care Compare group
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Fayetteville, GA
  • NPI 1013313857
  Medicare reassignment Care Compare group
• Privia Medical Group of Georgia LLC

  • Internal Medicine Physician
  • Savannah, GA
  • NPI 1356907273
  NPD

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

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1760812895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 N MAIN ST STE A",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132570",
            "telephone_number": "912-785-2100",
            "fax_number": "912-368-3868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 N MAIN ST STE A",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132570",
            "telephone_number": "912-785-2100",
            "fax_number": "912-368-3868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONANNI",
        "first_name": "STEPHEN",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-27",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "deactivation_date": "2025-03-25",
        "reactivation_date": "2025-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12279",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Georgia, Inc. (Fresenius Kidney Care Liberty County)
• Iiesha Black, LPC
• Tommy Dean Black Jr., EDS, LPC
• Josephine Block, RBT
• Andrew Boggs, APRN
• Bone and Joint Institute of South Georgia, P.C.
• Seth A Borquaye, M.D.
• Jaclyn Borrelli, BCBA
• Douglas A Boudreau, MD
• Kimberly Michelle Bounds

• Physician Assistant in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.