Provider Demographics
NPI:1508609140
Name:BONNER, SHEBA M
Entity type:Individual
Prefix:
First Name:SHEBA
Middle Name:M
Last Name:BONNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 ADAMSVILLE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-3824
Mailing Address - Country:US
Mailing Address - Phone:404-623-4063
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 508
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7637
Practice Address - Country:US
Practice Address - Phone:678-489-7384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health