Provider Demographics
NPI:1952913824
Name:BONDS, JUANITA BATES
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:BATES
Last Name:BONDS
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 1:450 CULLEN COPSE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7616
Mailing Address - Country:US
Mailing Address - Phone:470-626-3295
Mailing Address - Fax:225-224-6238
Practice Address - Street 1:3143 E SHADOWLAWN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2405
Practice Address - Country:US
Practice Address - Phone:678-213-2220
Practice Address - Fax:678-213-3331
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010352225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMT010352OtherLICENSE MASSAGE THERAPIST