Provider Demographics
NPI:1841756731
Name:WHATLEY, SONYA (NP)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:MANGUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 HUNTER TRL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-8318
Mailing Address - Country:US
Mailing Address - Phone:601-278-7067
Mailing Address - Fax:
Practice Address - Street 1:3091 HIGHWAY 49 S STE F
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9446
Practice Address - Country:US
Practice Address - Phone:601-782-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty