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General NPI Number Information
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NPI Number | 1639756364
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Entity Type | Individual
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Provider Name | SYDNEY KOENIG
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Gender | Female
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Dates
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Enumeration Date | 03/27/2021
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 401 W MAIN ST
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City | SWAINSBORO
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State | GA
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Zip | 30401-3110
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Country | US
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Telephone | 478-237-9928
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Fax | 478-763-3787
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Provider Business Mailing Address
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Address Line | 1123 PARIS AVE
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City | SWAINSBORO
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State | GA
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Zip | 30401-6062
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Country | US
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Telephone | 912-414-2033
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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 | 101835
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License Number State | GA
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