Provider Demographics
NPI:1578190005
Name:BONDE, KIMBERLY (LICAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BONDE
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 MEAD RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3625
Mailing Address - Country:US
Mailing Address - Phone:404-378-1543
Mailing Address - Fax:
Practice Address - Street 1:340 MEAD RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3625
Practice Address - Country:US
Practice Address - Phone:404-378-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00019171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist