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General NPI Number Information
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NPI Number | 1174796130
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Entity Type | Individual
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Provider Name | OLUSEGUN SONNY JOHN MD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 821 N COBB ST
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-2343
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Country | US
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Telephone | 478-452-0897
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Fax |
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Provider Business Mailing Address
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Address Line | 5925 BEAVER RIDGE DR
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City | CUMMING
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State | GA
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Zip | 30040-0240
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Country | US
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Telephone | 404-542-2731
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 059982
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 2024016618
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101245550
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024016618
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 203985
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License Number State | LA
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