Organization
JAYTYN LLC
Active
Other names
Jaytyn LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNY LEE BONNER SR. (MD)
(256) 457-3071
Entity
Organization
Contact information
Practice address
4600 BROSWELL ROAD, ATLANTA, GA 30342
(256) 457-3071
Mailing address
4310 BRONTE LN, DOUGLASVILLE, GA 30135-4981
(256) 457-3071
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67277
INTERNAL MEDICINE
GA
Enumeration date
03/08/2019
Last updated
04/24/2019
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