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General NPI Number Information
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NPI Number | 1902267974
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Entity Type | Individual
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Provider Name | BONNIE GRULLON-COOPER
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Gender | Female
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 80 JESSE HILL JR DR. BOX 88 GRADY HOSPITAL
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City | ATLANTA
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State | GA
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Zip | 30303
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Country | US
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Telephone | 404-616-0879
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Fax |
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Provider Business Mailing Address
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Address Line | 906 TORREY PINES COURT
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City | MCDONOUGH
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State | GA
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Zip | 30253
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Country | US
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Telephone | 478-320-2379
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN193456
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License Number State | GA
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