Healthcare Provider Details

I. General information

NPI: 1679735690
Provider Name (Legal Business Name): SONO PRO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 INDEPENDENCE ST
SPRINGFIELD TN
37172-7430
US

IV. Provider business mailing address

307 INDEPENDENCE ST
SPRINGFIELD TN
37172-7430
US

V. Phone/Fax

Practice location:
  • Phone: 615-478-5702
  • Fax:
Mailing address:
  • Phone: 615-478-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number92909
License Number StateTN

VIII. Authorized Official

Name: MR. JAMIE DWAYNE PENNINGTON
Title or Position: SONOGRAPHER/OWNER
Credential: RDMS, RVT, RDCS
Phone: 615-478-5702