Provider Demographics
NPI:1942663513
Name:SOREN THOMAS MD
Entity Type:Organization
Organization Name:SOREN THOMAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-391-9953
Mailing Address - Street 1:PO BOX 80042
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30366-0042
Mailing Address - Country:US
Mailing Address - Phone:770-458-0025
Mailing Address - Fax:678-601-0607
Practice Address - Street 1:5953 BUFORD HWY NE
Practice Address - Street 2:SUITE 208 & 202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30340-1375
Practice Address - Country:US
Practice Address - Phone:770-458-0025
Practice Address - Fax:678-601-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA026895261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD30112Medicare UPIN
GA01BDHKRMedicare PIN