Provider Demographics
NPI:1083779391
Name:SONYIKA, HAIBA (MD)
Entity Type:Individual
Prefix:DR
First Name:HAIBA
Middle Name:
Last Name:SONYIKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GORDON
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:155 CARNEGIE PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3981
Mailing Address - Country:US
Mailing Address - Phone:678-817-6991
Mailing Address - Fax:678-817-6992
Practice Address - Street 1:155 CARNEGIE PL
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3981
Practice Address - Country:US
Practice Address - Phone:678-817-6991
Practice Address - Fax:678-817-6992
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000441405KMedicaid
GA000441405HMedicaid
GA000441405HMedicaid