Provider Demographics
NPI:1063038388
Name:SONNTAG, JOSEPH G (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:SONNTAG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 3RD AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1900
Mailing Address - Country:US
Mailing Address - Phone:229-312-5802
Mailing Address - Fax:
Practice Address - Street 1:2336 DAWSON RD STE 2200
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-2801
Practice Address - Country:US
Practice Address - Phone:229-312-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11688207Q00000X
390200000X
GA90451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program