Provider Demographics
NPI:1457381089
Name:SORENSEN, CURTIS (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:SORENSEN
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 1:100 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2990
Mailing Address - Country:US
Mailing Address - Phone:706-653-0835
Mailing Address - Fax:706-653-8069
Practice Address - Street 1:100 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-2990
Practice Address - Country:US
Practice Address - Phone:706-653-0835
Practice Address - Fax:706-653-8069
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39947207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009922935OtherALABAMA MEDICAID
GA930103530OtherMEDICARE RAILROAD
GA000653452DMedicaid
GA001543OtherBLUE CROSS
GA001543OtherBLUE CROSS
AL009922935OtherALABAMA MEDICAID