MEDICARE: DR. MICHAEL JOHN SORNA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0802X	Addiction Psychiatry Physician	63739	GA
2	2084P0800X	Psychiatry Physician	ME87591	FL
3	2084P0800X	Psychiatry Physician	63739	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932100492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN SORNA M.D.

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 SHIRCLIFF WAY STE 601
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4776
Country	:	US
Telephone Number	:	904-308-3751
Fax Number	:	904-308-6890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/09/2019

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Directions to “ DR. MICHAEL JOHN SORNA M.D.” Practice Location

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