Healthcare Provider Details

I. General information

NPI: 1942165568
Provider Name (Legal Business Name): LASHONDRA BONNER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 THIRD AVE
MACON GA
31204-3016
US

IV. Provider business mailing address

2113 THIRD AVE
MACON GA
31204-3016
US

V. Phone/Fax

Practice location:
  • Phone: 299-644-2017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0030096958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: