Provider Demographics
NPI:1427561752
Name:THOMAS, SONYA MARCELLA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:MARCELLA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 CREPE MYRTLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-7532
Mailing Address - Country:US
Mailing Address - Phone:912-614-2137
Mailing Address - Fax:
Practice Address - Street 1:3120 N OAK STREET EXT STE B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5910
Practice Address - Country:US
Practice Address - Phone:229-671-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty