Provider Demographics
NPI:1679735690
Name:SONO PRO, LLC
Entity type:Organization
Organization Name:SONO PRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT, RDCS
Authorized Official - Phone:615-478-5702
Mailing Address - Street 1:307 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-7430
Mailing Address - Country:US
Mailing Address - Phone:615-478-5702
Mailing Address - Fax:
Practice Address - Street 1:307 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-7430
Practice Address - Country:US
Practice Address - Phone:615-478-5702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN92909261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile