Provider Demographics
NPI:1770878498
Name:WATLEY, SONIA R (MD)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:R
Last Name:WATLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:ROSALIN
Other - Last Name:QUINTEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:706-602-7800
Mailing Address - Fax:
Practice Address - Street 1:21 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2009
Practice Address - Country:US
Practice Address - Phone:770-773-9201
Practice Address - Fax:770-773-9219
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357106YPFLOtherMEDICARE
TXP9484OtherSTATE LICENSE