Provider Demographics
NPI:1386141877
Name:TAYLOR, SONYA POWELL (CERTIFIED HAIR LOSS)
Entity type:Individual
Prefix:MRS
First Name:SONYA
Middle Name:POWELL
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 DAN BRINSON RD
Mailing Address - Street 2:
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815-5211
Mailing Address - Country:US
Mailing Address - Phone:706-570-6188
Mailing Address - Fax:
Practice Address - Street 1:4922 ARMOUR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5233
Practice Address - Country:US
Practice Address - Phone:706-323-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO0850591744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management