1457381089 NPI number — CURTIS SORENSEN MD

Table of content: CURTIS SORENSEN MD (NPI 1457381089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457381089 NPI number — CURTIS SORENSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSEN
Provider First Name:
CURTIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457381089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BROOKSTONE CENTRE PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904-2990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-653-0835
Provider Business Mailing Address Fax Number:
706-653-8069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BROOKSTONE CENTRE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904-2990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-653-0835
Provider Business Practice Location Address Fax Number:
706-653-8069
Provider Enumeration Date:
07/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  39947 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 39947 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009922935 . This is a "ALABAMA MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 930103530 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000653452D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001543 . This is a "BLUE CROSS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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