Provider Demographics
NPI:1588915276
Name:SHIM, SORA (PA-C)
Entity type:Individual
Prefix:
First Name:SORA
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3755 SIXES RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7847
Mailing Address - Country:US
Mailing Address - Phone:770-720-1880
Mailing Address - Fax:770-704-7162
Practice Address - Street 1:3755 SIXES RD STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7847
Practice Address - Country:US
Practice Address - Phone:770-720-1880
Practice Address - Fax:770-704-7162
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant