Provider Demographics
NPI:1598319279
Name:PRATER, SONYA (LMT)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:PRATER
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ASHLEY GLN
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-6316
Mailing Address - Country:US
Mailing Address - Phone:843-540-0019
Mailing Address - Fax:
Practice Address - Street 1:3070 WINDWARD PLZ STE X2
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8773
Practice Address - Country:US
Practice Address - Phone:843-540-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH010926124Q00000X
GAMT014480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No124Q00000XDental ProvidersDental Hygienist