Healthcare Provider Details

I. General information

NPI: 1275590812
Provider Name (Legal Business Name): SONIA VALITA GEORGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 ROSWELL RD NE SUITE #44
MARIETTA GA
30062-8826
US

IV. Provider business mailing address

3535 ROSWELL RD. NE SUITE #44
MARIETTA GA
30062-8826
US

V. Phone/Fax

Practice location:
  • Phone: 678-560-3999
  • Fax: 678-560-3890
Mailing address:
  • Phone: 678-560-3999
  • Fax: 678-560-3890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number042251
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: