Provider Demographics
NPI:1861699969
Name:BONILHA, LEONARDO FATOR GOUVEA (MD , PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:FATOR GOUVEA
Last Name:BONILHA
Suffix:
Gender:M
Credentials:MD , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR STE 420
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8004
Practice Address - Country:US
Practice Address - Phone:803-434-8050
Practice Address - Fax:803-933-3005
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL301452084N0400X
GA908702084N0400X, 2084E0001X
SC301452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy