Provider Demographics
NPI:1497979595
Name:FYNEFACE, SONNY KALIYO
Entity Type:Individual
Prefix:
First Name:SONNY
Middle Name:KALIYO
Last Name:FYNEFACE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5759 WINCHESTER PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4085
Mailing Address - Country:US
Mailing Address - Phone:678-418-8392
Mailing Address - Fax:678-418-6742
Practice Address - Street 1:5759 WINCHESTER PL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4085
Practice Address - Country:US
Practice Address - Phone:678-418-8392
Practice Address - Fax:678-418-6742
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator