Provider Demographics
NPI:1629753942
Name:GARDNER, SONYA IKEA (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:IKEA
Last Name:GARDNER
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 MEADOWVIEW RD
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1134
Mailing Address - Country:US
Mailing Address - Phone:504-510-7692
Mailing Address - Fax:
Practice Address - Street 1:5930 MEADOWVIEW RD
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1134
Practice Address - Country:US
Practice Address - Phone:504-510-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy