Basic Information
| Provider Information | |||||||||
| NPI: | 1427122779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILES | ||||||||
| FirstName: | SONIA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1550 COLLEGE ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312071554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783012397 | ||||||||
| FaxNumber: | 4783012128 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 1ST ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783015930 | ||||||||
| FaxNumber: | 4783015932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 042667 | GA | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | 042667 | GA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 000872396A | 05 | GA | MEDICAID |