Provider Demographics
NPI:1912589979
Name:MCKENZIE, SONIA
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 MAYFAIR LN APT A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2864
Mailing Address - Country:US
Mailing Address - Phone:229-869-0440
Mailing Address - Fax:
Practice Address - Street 1:3715 MAYFAIR LN APT A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-2864
Practice Address - Country:US
Practice Address - Phone:229-869-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor