Provider Demographics
NPI:1922246768
Name:MANN, SOPHIA M
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:M
Last Name:MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:M
Other - Last Name:PETREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:156 RACCOON RUN
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-7326
Mailing Address - Country:US
Mailing Address - Phone:706-596-0383
Mailing Address - Fax:
Practice Address - Street 1:156 RACCOON RUN
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-7326
Practice Address - Country:US
Practice Address - Phone:706-596-0383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN055336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse