Healthcare Provider Details

I. General information

NPI: 1497046783
Provider Name (Legal Business Name): POOJA M SONI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 SHIELDS RD.
DALTON GA
30720
US

IV. Provider business mailing address

1933 SHIELDS RD.
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-6628
  • Fax: 706-272-3832
Mailing address:
  • Phone: 706-278-6628
  • Fax: 706-272-3832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71417
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: