Healthcare Provider Details

I. General information

NPI: 1588583264
Provider Name (Legal Business Name): BONNIE LOOPER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CARNEGIE PL
FAYETTEVILLE GA
30214-3905
US

IV. Provider business mailing address

100 SANDOWN DR
PEACHTREE CITY GA
30269-2276
US

V. Phone/Fax

Practice location:
  • Phone: 404-445-3968
  • Fax:
Mailing address:
  • Phone: 678-675-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: