Provider Demographics
NPI:1396270468
Name:SONA MEDSPA PHYSICIAN GROUP, PLLC
Entity type:Organization
Organization Name:SONA MEDSPA PHYSICIAN GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-233-3234
Mailing Address - Street 1:3340 ROBINWOOD RD STE 100-534
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6689
Mailing Address - Country:US
Mailing Address - Phone:980-233-3234
Mailing Address - Fax:
Practice Address - Street 1:14330 OAKHILL PARK LN STE 135
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3409
Practice Address - Country:US
Practice Address - Phone:704-544-7832
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121359207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty