Provider Demographics
NPI:1356501381
Name:SHELDON SOBLE DPM
Entity Type:Organization
Organization Name:SHELDON SOBLE DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-938-2920
Mailing Address - Street 1:2193 NORTHLAKE PKWY # 12-114
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4116
Mailing Address - Country:US
Mailing Address - Phone:770-938-2920
Mailing Address - Fax:
Practice Address - Street 1:2193 NORTHLAKE PKWY # 12-114
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4116
Practice Address - Country:US
Practice Address - Phone:770-938-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000331213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0784980001Medicare NSC