Provider Demographics
NPI:1639214158
Name:TANNEHILL, SONDRA SMITH (PA)
Entity Type:Individual
Prefix:MS
First Name:SONDRA
Middle Name:SMITH
Last Name:TANNEHILL
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2930 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3815
Mailing Address - Country:US
Mailing Address - Phone:910-323-9010
Mailing Address - Fax:910-323-9568
Practice Address - Street 1:2930 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3815
Practice Address - Country:US
Practice Address - Phone:910-323-9010
Practice Address - Fax:910-323-9568
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC00010-00774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical