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General NPI Number Information
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NPI Number | 1396270468
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Entity Type | Organization
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Legal Business Name | SONA MEDSPA PHYSICIAN GROUP, PLLC
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 14330 OAKHILL PARK LN STE 135
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3409
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Country | US
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Telephone | 704-544-7832
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Fax |
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Provider Business Mailing Address
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Address Line | 3340 ROBINWOOD RD STE 100-534
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City | GASTONIA
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State | NC
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Zip | 28054-6689
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Country | US
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Telephone | 980-233-3234
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAVID L BRYANT
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Credential |
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Telephone | 980-233-3234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NI0002X
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Taxonomy Name | Clinical & Laboratory Dermatological Immunology Physician
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License Number | 121359
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License Number State | NC
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