Healthcare Provider Details

I. General information

NPI: 1275937054
Provider Name (Legal Business Name): SONIA RILEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CLINIC AVE STE 101
CARROLLTON GA
30117
US

IV. Provider business mailing address

150 CLINIC AVE
CARROLLTON GA
30117-4401
US

V. Phone/Fax

Practice location:
  • Phone: 708-340-8737
  • Fax: 770-834-6118
Mailing address:
  • Phone: 770-834-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN159373
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN159373
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN159373
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: