Provider Demographics
NPI:1568572295
Name:HOLSTON, SONYA J (PA)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:J
Last Name:HOLSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 EDGEFIELD AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3910
Mailing Address - Country:US
Mailing Address - Phone:803-648-4224
Mailing Address - Fax:803-641-1984
Practice Address - Street 1:261 EDGEFIELD AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-648-4224
Practice Address - Fax:803-641-1984
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1138363A00000X
GA003032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0220PAMedicaid
SC0220PAMedicaid
Q08372Medicare UPIN