Provider Demographics
NPI:1053525121
Name:BONHAUS, STEPHANIE R (CNM)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:BONHAUS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6810
Mailing Address - Country:US
Mailing Address - Phone:771-941-7717
Mailing Address - Fax:770-948-9729
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:SUITE 500
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:771-941-7717
Practice Address - Fax:770-948-9729
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177260367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA919525076CMedicaid
GA919525076AMedicaid
GA919525076BMedicaid