Bonham, Deaxtra
Bonham, Deaxtra is an individual health care provider with primary practice located at 550 Peachtree St Ne Ste 1275 , Atlanta GA 30308-2240. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Women's Health, which is considered as her primary health care specialty. Bonham, Deaxtra can be contacted via phone (404) 872-3121.Contact Information
Primary practice address
550 Peachtree St Ne Ste 1275
Atlanta GA 30308-2240
Phone: (404) 872-3121
Fax: (404) 872-3119
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Women's Health | 363LW0102X | 0024173381 | Virginia |
| Physician Assistants & Advanced Practice Nursing Providers / Women's Health | 363LW0102X | 5009520 | North Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Women's Health | 363LW0102X | GAA-NP000016 | Georgia |
Profile Details
| NPI number | 1487100566 |
|---|---|
| LBN Legal business name | Bonham, Deaxtra |
| Credentials | Women's Health Nurse Practitioner (WHNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 29th, 2016 |
| Last updated | Dec 6th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487100566 | NPPES |
| Georgia | MEDICAID | 003254615 |
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