Healthcare Provider Details

I. General information

NPI: 1770674871
Provider Name (Legal Business Name): SONYA MABRY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/30/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 BALL GROUND HWY
BALL GROUND GA
30107
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4011
  • Fax:
Mailing address:
  • Phone: 770-914-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number077192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: