Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003270 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003270 | VA |
NPI | 1003907536 |
---|---|
Provider Name | Dr. Sonya Yvette Medina |
First Address | Augusta, GA 30904-6258 |
Second Address | Augusta, GA 30904-6258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 15/08/2013 |