Provider Demographics
NPI:1033324751
Name:COLEY, SOPHIA WAYE (DMD)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:WAYE
Last Name:COLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 961480
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6906
Mailing Address - Country:US
Mailing Address - Phone:770-991-9925
Mailing Address - Fax:
Practice Address - Street 1:653 ROBERTS DR STE B
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2959
Practice Address - Country:US
Practice Address - Phone:770-991-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist