Provider Demographics
NPI:1174045942
Name:SONOMILLIONS LLC
Entity Type:Organization
Organization Name:SONOMILLIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOYKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CVT
Authorized Official - Phone:404-723-7662
Mailing Address - Street 1:2136 SHOOP CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6996
Mailing Address - Country:US
Mailing Address - Phone:404-723-7662
Mailing Address - Fax:
Practice Address - Street 1:1980 RIDGESTONE RUN SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4088
Practice Address - Country:US
Practice Address - Phone:404-449-8216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service