Provider Demographics
NPI:1386630358
Name:SCHOBORG, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:SCHOBORG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE STE 510
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4211
Mailing Address - Country:US
Mailing Address - Phone:140-455-6805
Mailing Address - Fax:404-521-2977
Practice Address - Street 1:285 BOULEVARD NE STE 510
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4211
Practice Address - Country:US
Practice Address - Phone:404-524-5082
Practice Address - Fax:404-521-2977
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2021-05-12
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
GA016834174400000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000193729AMedicaid