Provider Demographics
NPI:1609207208
Name:SPARKS, BONNIE (APRN NP-BC)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SPARKS
Suffix:
Gender:F
Credentials:APRN NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4566
Mailing Address - Country:US
Mailing Address - Phone:404-274-3273
Mailing Address - Fax:
Practice Address - Street 1:1762 CLIFTON ROAD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:404-778-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA166564363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health