Provider Demographics
NPI:1043770399
Name:NORMAN, SOPHIA DELORISE (LPN 059343)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:DELORISE
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LPN 059343
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 TREES OF KENNESAW PKWY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-8223
Mailing Address - Country:US
Mailing Address - Phone:404-491-5190
Mailing Address - Fax:
Practice Address - Street 1:2701 TREES OF KENNESAW PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-8223
Practice Address - Country:US
Practice Address - Phone:404-491-5190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059343164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse