| Bonnie P Ellenoff, DO | |
|
3640 Tramore Pointe Pkwy, Kaiser Permanente West Cobb Medical Center, Austell, GA 30106-6825 | |
| (770) 439-4700 | |
| (404) 370-0428 |
| Full Name | Bonnie P Ellenoff |
|---|---|
| Gender | Female |
| Speciality | Family Practice |
| Experience | 26 Years |
| Location | 3640 Tramore Pointe Pkwy, Austell, Georgia |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306907001 | NPI | - | NPPES |
| 0009593950 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 051644 (Georgia) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Southeast Permanente Medical Group | 6204829013 | 658 |
| Entity Name | The Southeast Permanente Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245266956 PECOS PAC ID: 6204829013 Enrollment ID: O20040407000370 |
| Mailing Address | Practice Location Address |
|---|---|
| Bonnie P Ellenoff, DO 3495 Piedmont Rd Ne, Nine Piedmont Center, Atlanta, GA 30305-1717 Ph: (404) 504-5678 | Bonnie P Ellenoff, DO 3640 Tramore Pointe Pkwy, Kaiser Permanente West Cobb Medical Center, Austell, GA 30106-6825 Ph: (770) 439-4700 |
Jennifer Nicole Garrett, PA-C Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3825 Medical Park Dr Ste 301, Austell, GA 30106 Phone: 770-874-0692 | |
Bradley Stearns, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3950 Austell Rd, Austell, GA 30106 Phone: 770-732-4000 | |
Dr. Chibuzor Steve Eke, MBBCH, MPH, MSN, FNP Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1668 Mulkey Rd Ste G, Austell, GA 30106 Phone: 404-585-4964 Fax: 404-581-5838 | |
Dr. Erica Judge Edwards, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1790 Mulkey Rd Ste 8a, Austell, GA 30106 Phone: 770-944-1830 Fax: 770-739-0260 | |
Dr. Justin Park, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 1664 Mulkey Rd, Austell, GA 30106 Phone: 770-422-1372 | |
Dr. Shin Long Liao, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 3950 Austell Rd, Austell, GA 30106 Phone: 770-732-4010 |