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: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date: 03/24/2006
Reactivation Date: 04/18/2006

III. Provider practice location address

2411 SAINT CROIX CIR
MARIETTA GA
30062-6528
US

IV. Provider business mailing address

2411 SAINT CROIX CIR
MARIETTA GA
30062-6528
US

V. Phone/Fax

Practice location:
  • Phone: 404-556-5082
  • Fax: 770-993-9058
Mailing address:
  • Phone: 404-556-5082
  • Fax: 770-993-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: