Healthcare Provider Details

I. General information

NPI: 1386630358
Provider Name (Legal Business Name): THOMAS W SCHOBORG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date: 03/24/2006
Reactivation Date: 04/18/2006

III. Provider practice location address

285 BOULEVARD NE STE 510
ATLANTA GA
30312-4211
US

IV. Provider business mailing address

285 BOULEVARD NE STE 510
ATLANTA GA
30312-4211
US

V. Phone/Fax

Practice location:
  • Phone: 404-524-5082
  • Fax: 404-521-2977
Mailing address:
  • Phone: 140-455-6805
  • Fax: 404-521-2977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number016834
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number016834
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: