Healthcare Provider Details

I. General information

NPI: 1730110917
Provider Name (Legal Business Name): SONI & SONI M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL ARTS BLDG
ETOWAH TN
37331-0500
US

IV. Provider business mailing address

PO BOX 500 109 GRADY RD SUITE B
E TOWAH TN
37331
US

V. Phone/Fax

Practice location:
  • Phone: 423-263-1147
  • Fax: 423-263-5704
Mailing address:
  • Phone: 423-263-1147
  • Fax: 423-263-5704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0000009198
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0000009198
License Number StateTN

VIII. Authorized Official

Name: DR. HARISH B SONI
Title or Position: OWNER
Credential: MD
Phone: 423-263-1147