Provider Demographics
NPI:1396383063
Name:BONDS, LEANDER M
Entity Type:Individual
Prefix:
First Name:LEANDER
Middle Name:M
Last Name:BONDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2196 SCARBROUGH DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-4312
Mailing Address - Country:US
Mailing Address - Phone:478-765-6680
Mailing Address - Fax:
Practice Address - Street 1:2196 SCARBROUGH DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-4312
Practice Address - Country:US
Practice Address - Phone:478-765-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver