Healthcare Provider Details

I. General information

NPI: 1134770407
Provider Name (Legal Business Name): SOHNA FLORENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 SAGAMORE CT
DALLAS GA
30132-6709
US

IV. Provider business mailing address

61 SAGAMORE CT
DALLAS GA
30132-6709
US

V. Phone/Fax

Practice location:
  • Phone: 404-422-7506
  • Fax:
Mailing address:
  • Phone: 404-422-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN246425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: