Healthcare Provider Details

I. General information

NPI: 1154384378
Provider Name (Legal Business Name): SONYA MARIA COOK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2739 LAUREL ST
COLUMBIA SC
29204-2028
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-4800
  • Fax: 803-256-0397
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: