Provider Demographics
NPI:1780692913
Name:GEORGE, SONYA R (DC)
Entity type:Individual
Prefix:DR
First Name:SONYA
Middle Name:R
Last Name:GEORGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8204
Mailing Address - Country:US
Mailing Address - Phone:803-534-7110
Mailing Address - Fax:803-534-8882
Practice Address - Street 1:1107 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8204
Practice Address - Country:US
Practice Address - Phone:803-534-7110
Practice Address - Fax:803-534-8882
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH465Medicaid
SCGCH465Medicaid