Basic Information
| Provider Information | |||||||||
| NPI: | 1780687624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOHNER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1090 | ||||||||
| Address2: | |||||||||
| City: | HARTSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295511090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438570111 | ||||||||
| FaxNumber: | 8438570206 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 SUMTER HWY | ||||||||
| Address2: | |||||||||
| City: | BISHOPVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290107601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034845317 | ||||||||
| FaxNumber: | 8034844533 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18983 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 189833 | 05 | SC | MEDICAID |