Provider Demographics
NPI:1891538625
Name:HARRIS, SONJA MARIE (LDO, NCLEC, ABOC)
Entity type:Individual
Prefix:MS
First Name:SONJA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LDO, NCLEC, ABOC
Other - Prefix:MS
Other - First Name:SONJA
Other - Middle Name:MARIE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LDO, ABOC, NCLEC
Mailing Address - Street 1:3209 DEANS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-4201
Mailing Address - Country:US
Mailing Address - Phone:706-796-6600
Mailing Address - Fax:706-796-6999
Practice Address - Street 1:3209 DEANS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4201
Practice Address - Country:US
Practice Address - Phone:706-796-6600
Practice Address - Fax:706-796-6999
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001971156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician