Provider Demographics
NPI:1194026328
Name:KETCHAM, SONYA LEE
Entity Type:Individual
Prefix:MS
First Name:SONYA
Middle Name:LEE
Last Name:KETCHAM
Suffix:
Gender:F
Credentials:
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 309
Mailing Address - Street 2:
Mailing Address - City:ARITON
Mailing Address - State:AL
Mailing Address - Zip Code:36311
Mailing Address - Country:US
Mailing Address - Phone:334-369-9063
Mailing Address - Fax:
Practice Address - Street 1:403 DOTHAN RD
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36103
Practice Address - Country:US
Practice Address - Phone:334-369-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other