Provider Demographics
NPI:1295966216
Name:BONSERVA ACUTE PRIMARY CARE CENTER
Entity type:Organization
Organization Name:BONSERVA ACUTE PRIMARY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:PLESHETTE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-366-8111
Mailing Address - Street 1:4940 GOVERNORS DR STE 209
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-2186
Mailing Address - Country:US
Mailing Address - Phone:404-366-8111
Mailing Address - Fax:404-366-8102
Practice Address - Street 1:4940 GOVERNORS DR STE 209
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2186
Practice Address - Country:US
Practice Address - Phone:404-366-8111
Practice Address - Fax:404-366-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care