MRS. DEAXTRA BONHAM WHNP NPI 1487100566

NPI Information

NPI: 1487100566
Provider Name: MRS. DEAXTRA BONHAM, WHNP
Classification: Nurse Practitioner - 363LW0102X
Entity Type: Individual

Specialization: Women's Health

PECOS Registration: Yes

Address:
550 PEACHTREE ST NE STE 1275
ATLANTA, GA
ZIP 30308
Phone: (404) 872-3121
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MRS. Deaxtra Bonham, WHNP is a women's health nurse practitioner in Atlanta, GA. MRS. Deaxtra Bonham, WHNP NPI is 1487100566. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

550 PEACHTREE ST NE STE 1275
ATLANTA, GA
ZIP 30308-240
Phone: (404) 872-3121
Fax: (404) 872-3119

The NPI 1487100566 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/29/2016 and was last updated on 12/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LW0102X	Nurse Practitioner	Women's Health	0024173381	VIRGINIA	No
2	363LW0102X	Nurse Practitioner	Women's Health	5009520	NORTH CAROLINA	No
3	363LW0102X	Nurse Practitioner	Women's Health	GAA-NP000016	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	003254615	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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