Provider Demographics
NPI:1700696705
Name:WILKS, SUNNY LYNDORA
Entity type:Individual
Prefix:
First Name:SUNNY
Middle Name:LYNDORA
Last Name:WILKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUNNY
Other - Middle Name:
Other - Last Name:WILKS-GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:808 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2317
Mailing Address - Country:US
Mailing Address - Phone:662-322-9290
Mailing Address - Fax:
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2173
Practice Address - Country:US
Practice Address - Phone:423-778-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health