Provider Demographics
NPI:1063153138
Name:ATKINSON BARTLEY, SONYA CHANEL
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:CHANEL
Last Name:ATKINSON BARTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 LENA LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6200
Mailing Address - Country:US
Mailing Address - Phone:252-367-2147
Mailing Address - Fax:
Practice Address - Street 1:3517 LENA LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6200
Practice Address - Country:US
Practice Address - Phone:252-367-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8312496172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver