Provider Demographics
NPI:1588604672
Name:PEPPERS, SONYA ANISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:SONYA
Middle Name:ANISSA
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11739 DAVENTRY DR NW
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7527
Mailing Address - Country:US
Mailing Address - Phone:501-765-5662
Mailing Address - Fax:501-377-9232
Practice Address - Street 1:11739 DAVENTRY DR NW
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7527
Practice Address - Country:US
Practice Address - Phone:501-765-5662
Practice Address - Fax:501-377-9232
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2657207R00000X
OH35126974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141305001Medicaid
OH35126974OtherSTATE LICENSE
ARE2657OtherSTATE LICENSE
ARE2657OtherSTATE LICENSE