Healthcare Provider Details

I. General information

NPI: 1972018117
Provider Name (Legal Business Name): NATALIE BERNETT BONNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DEVANT ST
FAYETTEVILLE GA
30214-2710
US

IV. Provider business mailing address

810 KIRKLY WAY
FAIRBURN GA
30213-2482
US

V. Phone/Fax

Practice location:
  • Phone: 770-703-4448
  • Fax:
Mailing address:
  • Phone: 706-332-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP150033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: