NPIMap

Organization Active NPI

Personalized Wellness

  • General Practice Physician
  • Ridgeland, MS
National Provider Identifier
1942740188
Registry record updated Mar 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
13234 Issued in MS
Legal business name
PERSONALIZED WELLNESS
Practice address
573 Highway 51 Ste D
Ridgeland, MS 39157-2605
Phone
(601) 955-1804
NPI assigned
Mar 7, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2017

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

Authorized official

Name
Donald R Bonner, D.O.
Title
Owner
Phone
(601) 955-1804

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X 13234 MS Primary

Addresses

Primary practice location

573 Highway 51 Ste D
Ridgeland, MS 39157-2605

Mailing address

573 Highway 51 Ste D
Ridgeland, MS 39157-2605
Phone (601) 955-1804

National Provider Directory

National Provider Directory
Tax ID family
Personalized Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

573 Highway 51
Ste D
Ridgeland, MS 39157
Phone (601) 955-1804

NPI Registry JSON

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1942740188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "573 HIGHWAY 51 STE D",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572605",
            "telephone_number": "601-955-1804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "573 HIGHWAY 51 STE D",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572605",
            "telephone_number": "601-955-1804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERSONALIZED WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-07",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-955-1804",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MS",
            "license": "13234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; 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.