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General NPI Number Information
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NPI Number | 1285375774
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Entity Type | Individual
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Provider Name | LISA BONNER
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Gender | Female
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 2544 MCCLAVE DR STE. #210 PMB1046
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City | ATLANTA
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State | GA
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Zip | 30340-1952
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Country | US
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Telephone | 404-600-7014
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Fax |
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Provider Business Mailing Address
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Address Line | 2544 MCCLAVE DR. STE. #210 PMB1046
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City | ATLANTA
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State | GA
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Zip | 30340-1952
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Country | US
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Telephone | 404-600-7014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State |
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