Provider Demographics
NPI:1396784666
Name:THOMAS, SOREN (MD)
Entity type:Individual
Prefix:DR
First Name:SOREN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5953 BUFORD HWY NE
Mailing Address - Street 2:STE 202
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-1375
Mailing Address - Country:US
Mailing Address - Phone:770-458-0025
Mailing Address - Fax:404-900-9205
Practice Address - Street 1:5953 BUFORD HWY NE STE 202
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-1375
Practice Address - Country:US
Practice Address - Phone:770-458-0025
Practice Address - Fax:404-900-9205
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026895207P00000X
GA26895208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000335827AAMedicaid
GA000335827AAMedicaid
GAD30112Medicare UPIN