Healthcare Provider Details

I. General information

NPI: 1063153138
Provider Name (Legal Business Name): SONYA CHANEL ATKINSON BARTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 LENA LN
GREENVILLE NC
27834-6200
US

IV. Provider business mailing address

3517 LENA LN
GREENVILLE NC
27834-6200
US

V. Phone/Fax

Practice location:
  • Phone: 252-367-2147
  • Fax:
Mailing address:
  • Phone: 252-367-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number8312496
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: