1669530903 NPI number — MRS. SONYA LEE WISDOM LPTA

Table of content: MRS. SONYA LEE WISDOM LPTA (NPI 1669530903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669530903 NPI number — MRS. SONYA LEE WISDOM LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISDOM
Provider First Name:
SONYA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MONTGOMERY
Provider Other First Name:
SONYA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669530903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3160 EASTOVER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-449-2266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 N UNIVERSITY
Provider Second Line Business Practice Location Address:
NHC MURFREESBORO
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-893-2602
Provider Business Practice Location Address Fax Number:
615-890-1224
Provider Enumeration Date:
12/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  TNPTA1891 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225200000X , with the licence number: ALPTA762 ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)