Provider Demographics
NPI:1285441295
Name:UPTON, SONYA CAROL (RD, LD)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:CAROL
Last Name:UPTON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 JOHN GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4307
Mailing Address - Country:US
Mailing Address - Phone:601-807-0075
Mailing Address - Fax:
Practice Address - Street 1:124 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3914
Practice Address - Country:US
Practice Address - Phone:601-807-0075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD0565133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered