Individual
LISA BONNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2544 MCCLAVE DR, STE. #210 PMB1046, ATLANTA, GA 30340-1952
(404) 600-7014
Mailing address
2544 MCCLAVE DR., STE. #210 PMB1046, ATLANTA, GA 30340-1952
(404) 600-7014
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
04/06/2022
Last updated
08/26/2025
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