Provider Demographics
NPI:1043845738
Name:BHAKTA, SONYABEN (DACM, LAC)
Entity type:Individual
Prefix:
First Name:SONYABEN
Middle Name:
Last Name:BHAKTA
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NORTHSIDE XING
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2373
Mailing Address - Country:US
Mailing Address - Phone:760-920-6901
Mailing Address - Fax:
Practice Address - Street 1:1950 NORTHSIDE XING
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2373
Practice Address - Country:US
Practice Address - Phone:478-200-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18802171100000X
GA538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty