Provider Demographics
NPI:1144383142
Name:ROWLAND, SONYA BURGESS (PHD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:BURGESS
Last Name:ROWLAND
Suffix:
Gender:F
Credentials:PHD
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 2334
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-2334
Mailing Address - Country:US
Mailing Address - Phone:678-575-3550
Mailing Address - Fax:404-297-4002
Practice Address - Street 1:1012 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2944
Practice Address - Country:US
Practice Address - Phone:678-575-3550
Practice Address - Fax:404-297-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2124103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00763166BMedicaid