Provider Demographics
NPI:1881814820
Name:FACKLER, SONDRALYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SONDRALYN
Middle Name:M
Last Name:FACKLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:125 PLANTATION CENTRE DR S
Mailing Address - Street 2:BLDG. 600 SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2079
Mailing Address - Country:US
Mailing Address - Phone:478-474-6467
Mailing Address - Fax:478-474-6407
Practice Address - Street 1:125 PLANTATION CENTRE DR S
Practice Address - Street 2:BLDG. 600 SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2079
Practice Address - Country:US
Practice Address - Phone:478-474-6467
Practice Address - Fax:478-474-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0442112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry