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General NPI Number Information
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NPI Number | 1780756643
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Entity Type | Individual
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Provider Name | JERALYN WOOD BONNER MSW
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE SUITE 508
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 404-636-1108
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Fax | 404-636-9482
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Provider Business Mailing Address
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Address Line | 2801 BUFORD HWY NE SUITE 508
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City | ATLANTA
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State | GA
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Zip | 30329-2149
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Country | US
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Telephone | 404-636-1108
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Fax | 404-636-9482
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 585
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 197
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License Number State | GA
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