Provider Demographics
NPI:1922133479
Name:CLEMONS, BONNIE SOLLENBERGER (WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:SOLLENBERGER
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 WILLIS ROAD
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30204
Mailing Address - Country:US
Mailing Address - Phone:706-646-2572
Mailing Address - Fax:
Practice Address - Street 1:1798 WILLIS ROAD
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204
Practice Address - Country:US
Practice Address - Phone:706-646-2572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063152363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health