Provider Demographics
NPI:1295984979
Name:DOUGHLIN, SONJA (MD)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:
Last Name:DOUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:404-605-5000
Mailing Address - Fax:
Practice Address - Street 1:2100 RIVEREDGE PKWY STE 5005TH
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4693
Practice Address - Country:US
Practice Address - Phone:866-949-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310782207R00000X
FLME137554207R00000X
SC36332207R00000X
GA078289207RH0002X
GA78289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01345707OtherRAILROAD MEDICARE
SC363323Medicaid
SCP01345707OtherRAILROAD MEDICARE
SCSC23575019Medicare PIN