Basic Information
Provider Information
NPI: 1477501047
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLLINS
FirstName: SONYA
MiddleName: R
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 902 MCCALLIE AVE
Address2:  
City: CHATTANOOGA
State: TN
PostalCode: 374032724
CountryCode: US
TelephoneNumber: 4236644460
FaxNumber:  
Practice Location
Address1: 304 TURNER MCCALL BLVD SW
Address2:  
City: ROME
State: GA
PostalCode: 301655621
CountryCode: US
TelephoneNumber: 7065095000
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/05/2006
LastUpdateDate: 09/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X56979GAY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
2080N0001X36394TNN Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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