Provider Demographics
NPI:1326564501
Name:ASH, SONJA NIKISHA
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:NIKISHA
Last Name:ASH
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 1:2321 KATY CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-6696
Mailing Address - Country:US
Mailing Address - Phone:229-395-3415
Mailing Address - Fax:
Practice Address - Street 1:2321 KATY CT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-6696
Practice Address - Country:US
Practice Address - Phone:229-395-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAB17-000536171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor