Healthcare Provider Details

I. General information

NPI: 1659359966
Provider Name (Legal Business Name): SONJA R EUBANKS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

104 AZALEA CT
MEBANE NC
27302-8162
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-8064
  • Fax:
Mailing address:
  • Phone: 336-256-1174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: