Healthcare Provider Details

I. General information

NPI: 1417527060
Provider Name (Legal Business Name): SONIA R. AMPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2021
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 RESEARCH CT # 125
SUWANEE GA
30024-6606
US

IV. Provider business mailing address

5123 WELLSLEY BND
ALPHARETTA GA
30005-5067
US

V. Phone/Fax

Practice location:
  • Phone: 404-410-7600
  • Fax:
Mailing address:
  • Phone: 678-675-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78353
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-169239
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: