Healthcare Provider Details

I. General information

NPI: 1013805993
Provider Name (Legal Business Name): ANGEL BONO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4083 CLOUD SPRINGS RD
RINGGOLD GA
30736-8411
US

IV. Provider business mailing address

4215 3RD AVE APT A
CHATTANOOGA TN
37416-3365
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone: 423-414-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number102984
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: