Provider Demographics
NPI:1285815258
Name:ATLANTA UROLOGICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ATLANTA UROLOGICAL GROUP, P.C.
Other - Org Name:THOMAS W SCHOBORG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHOBORG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-524-5082
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:STE 215
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-524-5082
Mailing Address - Fax:404-521-2977
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:STE 215
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-524-5082
Practice Address - Fax:404-521-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP871Medicare PIN