Provider Demographics
NPI:1497908446
Name:GEORGIANNA WALKER SORENSEN PHD PLC
Entity Type:Organization
Organization Name:GEORGIANNA WALKER SORENSEN PHD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIANNA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-676-4700
Mailing Address - Street 1:237 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3705
Mailing Address - Country:US
Mailing Address - Phone:863-676-4700
Mailing Address - Fax:863-676-4707
Practice Address - Street 1:237 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3705
Practice Address - Country:US
Practice Address - Phone:863-676-4700
Practice Address - Fax:863-676-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP82019-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4028Medicare PIN