Healthcare Provider Details

I. General information

NPI: 1013646876
Provider Name (Legal Business Name): SORAYA DJADJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 DAWSON RD STE 2200
ALBANY GA
31707-2801
US

IV. Provider business mailing address

2336 DAWSON RD STE 2200
ALBANY GA
31707-2801
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-8878
  • Fax: 229-312-8743
Mailing address:
  • Phone: 229-312-8878
  • Fax: 229-312-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2026-0253
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number99011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: