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Search › Georgia › 363LW0102X

Deaxtra Bonham, WHNP

NPI 1487100566 · on the registry since 2016

Practice

Address
550 Peachtree St Ne Ste 1275
Atlanta, GA 30308
Phone
(404) 872-3121
Fax
(404) 872-3119
Organisation at this address
Aga, Llc
Aga, Llc
Hypersphere
See Baby, Llc
Neuropath, Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
946

Additional practice sites

  • 15425 Warwick Blvd Ste H, Newport News, VA
  • 4714 Marshall Ave, Newport News, VA
  • 4714 Marshall Ave, Newport News, VA

Registry record

Primary taxonomy
363LW0102X
363LW0102X
Also registered as
363LW0102X
363LW0102X
Licence states on file
VA, NC, GA
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2021-12-06

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia