Healthcare Provider Details

I. General information

NPI: 1982778221
Provider Name (Legal Business Name): SONIE MARIE CLAYTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 20TH ST
COLUMBUS GA
31901-1848
US

IV. Provider business mailing address

PO BOX 1038
COLUMBUS GA
31902-1038
US

V. Phone/Fax

Practice location:
  • Phone: 706-324-7295
  • Fax:
Mailing address:
  • Phone: 706-660-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN113665
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: