Provider Demographics
NPI:1316984552
Name:SONI, GURBAX
Entity type:Individual
Prefix:
First Name:GURBAX
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 SHANNON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6322
Mailing Address - Country:US
Mailing Address - Phone:800-291-4020
Mailing Address - Fax:919-419-7247
Practice Address - Street 1:898 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-1261
Practice Address - Country:US
Practice Address - Phone:800-291-4020
Practice Address - Fax:919-419-7247
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039610207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316984552Medicaid