Provider Demographics
NPI:1366842494
Name:MEDICI MEDICAL ARTS
Entity Type:Organization
Organization Name:MEDICI MEDICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOSANJH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-328-4624
Mailing Address - Street 1:2911 GEORGE BUSBEE PKWY NW
Mailing Address - Street 2:SUITE 50
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6908
Mailing Address - Country:US
Mailing Address - Phone:844-328-4624
Mailing Address - Fax:770-882-2576
Practice Address - Street 1:2911 GEORGE BUSBEE PKWY NW
Practice Address - Street 2:SUITE 50
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6908
Practice Address - Country:US
Practice Address - Phone:844-328-4624
Practice Address - Fax:770-882-2576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA666862081P2900X
GA349208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1366842494OtherGROUP NPI
GA003161420AMedicaid
GA202G701420Medicare PIN
GA1366842494OtherGROUP NPI