Healthcare Provider Details

I. General information

NPI: 1437443678
Provider Name (Legal Business Name): SOBENNA GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 06/06/2022
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 420
ATLANTA GA
30342-4755
US

IV. Provider business mailing address

5445 MERIDIAN MARK RD STE 420
ATLANTA GA
30342-4755
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax: 404-785-9022
Mailing address:
  • Phone: 404-785-5437
  • Fax: 404-785-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number73458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: