Individual
BONITA L BROCKMAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2041 MESA VALLEY WAY, STE 185, AUSTELL, GA 30106
(404) 785-8900
(404) 785-8948
Mailing address
361 NELMS AVE, ATLANTA, GA 30307
(404) 822-7712
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
045410
GA
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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