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General NPI Number Information
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NPI Number | 1679735690
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Entity Type | Organization
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Legal Business Name | SONO PRO, LLC
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 307 INDEPENDENCE ST
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City | SPRINGFIELD
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State | TN
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Zip | 37172-7430
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Country | US
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Telephone | 615-478-5702
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Fax |
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Provider Business Mailing Address
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Address Line | 307 INDEPENDENCE ST
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City | SPRINGFIELD
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State | TN
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Zip | 37172-7430
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Country | US
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Telephone | 615-478-5702
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Fax |
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Authorized Official
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Title or Position | SONOGRAPHER/OWNER
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Name | MR. JAMIE DWAYNE PENNINGTON
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Credential | RDMS, RVT, RDCS
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Telephone | 615-478-5702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 92909
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License Number State | TN
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