MEDICARE: SONJA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1487509642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJA CLARK

Provider Business Mailing Address
First Line	:	2316 S WHITEHILL DR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3744
Country	:	US
Telephone Number	:	804-943-3866
Fax Number	:

Provider Business Practice Location Address
First Line	:	2316 S WHITEHILL DR
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3744
Country	:	US
Telephone Number	:	804-943-3866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “ SONJA CLARK ” Practice Location

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