Provider Demographics
NPI:1881890143
Name:SONI, HARISH B (MD)
Entity type:Individual
Prefix:DR
First Name:HARISH
Middle Name:B
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-0365
Mailing Address - Country:US
Mailing Address - Phone:423-263-9089
Mailing Address - Fax:423-263-9089
Practice Address - Street 1:1033 DW LILLARD MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1840
Practice Address - Country:US
Practice Address - Phone:423-263-9089
Practice Address - Fax:423-263-9089
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006386OtherBCBS OF TN
TN0035Medicaid
TN3196757Medicare ID - Type Unspecified
TNB04722Medicare UPIN