Provider Demographics
NPI:1790701357
Name:BONNER, KAREN F (PAAA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:F
Last Name:BONNER
Suffix:
Gender:F
Credentials:PAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 PEACHTREE RD NW
Mailing Address - Street 2:STE 515
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-5219
Mailing Address - Country:US
Mailing Address - Phone:404-351-1754
Mailing Address - Fax:404-351-7121
Practice Address - Street 1:1984 PEACHTREE RD NW
Practice Address - Street 2:STE 515
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-5219
Practice Address - Country:US
Practice Address - Phone:404-351-1754
Practice Address - Fax:404-351-7121
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2557367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R80888Medicare UPIN
43ZCBJA48Medicare ID - Type Unspecified