Provider Demographics
NPI:1992536213
Name:SOMERSET MEDICAL LLC
Entity type:Organization
Organization Name:SOMERSET MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-444-9418
Mailing Address - Street 1:815 MYRTLE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-4309
Mailing Address - Country:US
Mailing Address - Phone:404-444-9418
Mailing Address - Fax:
Practice Address - Street 1:659 AUBURN AVE NE STE 505
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1903
Practice Address - Country:US
Practice Address - Phone:404-444-9418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty