Basic Information
Provider Information
NPI: 1851851638
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GEEVARUGHESE
FirstName: SONIA
MiddleName: SAMJI
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 742616
Address2:  
City: ATLANTA
State: GA
PostalCode: 303742616
CountryCode: US
TelephoneNumber: 7702198420
FaxNumber:  
Practice Location
Address1: 743 SPRING ST NE
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013715
CountryCode: US
TelephoneNumber: 7702199000
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/20/2019
LastUpdateDate: 08/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X91933GAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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