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NPI Code Detail

MEDICARE: ELISSA HANDLEY TYSON BONNER MD

MEDICARE: ELISSA HANDLEY TYSON BONNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD.38980AL

General Provider Information

NPI Number : 1780178269
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISSA HANDLEY TYSON BONNER MD
Provider Business Mailing Address
First Line : 2152 OLD SPRINGVILLE RD
Second Line :
City : CENTER POINT
State : AL
Zip : 35215-4005
Country : US
Telephone Number : 205-838-6000
Fax Number : 205-838-6078
Provider Business Practice Location Address
First Line : 2152 OLD SPRINGVILLE RD
Second Line :
City : CENTER POINT
State : AL
Zip : 35215-4005
Country : US
Telephone Number : 205-838-6000
Fax Number : 205-838-6078
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2018
Last Update Date : 03/27/2026

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