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General NPI Number Information
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NPI Number | 1639375868
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Entity Type | Organization
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Legal Business Name | SONI AND SONI PEDIATRICS AND SURGERY
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 109 GRADY RD STE B
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City | ETOWAH
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State | TN
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Zip | 37331-1919
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Country | US
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Telephone | 423-263-6486
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Fax | 423-263-5704
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | ETOWAH
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State | TN
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Zip | 37331-0500
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Country | US
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Telephone | 423-263-1147
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Fax | 423-263-5704
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MISTY D IRVIN
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Credential |
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Telephone | 423-263-1147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9198
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License Number State | TN
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