Basic Information
| Provider Information | |||||||||
| NPI: | 1730636457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMJADI | ||||||||
| FirstName: | SOGOL | ||||||||
| MiddleName: | SARA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY STE 300 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3001 SAINT ROSE PKWY | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026165000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2016 | ||||||||
| LastUpdateDate: | 12/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO2624 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.