MR. JACK LEE SORG (NPI# 1407941131) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407941131 |
| Entity Type | Individual |
| Full Name | MR. JACK LEE SORG |
| Credential | MD |
| Practice Address |
1301 Well Brook Circle Conyers GA 30012-3873 |
| Mailing Address |
1301 Wellbrook Circle Ne Conyers GA 30012-3873 |
| Practice Telephone | 7709223023 |
| Practice Fax Number | 7709291016 |
| Mailing Telephone | 7709223023 |
| Mailing Fax Number | 7709291016 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-01-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 016434 | GA | Allopathic & Osteopathic Physicians |
| Street Address |
1301 WELL BROOK CIRCLE |
| City | CONYERS |
| State | GA |
| Zip Code | 30012-3873 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457446171 | James Ransford De Give | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1588759211 | Jason Dale Anderson | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1033204748 | Marshall David Almand | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1104911817 | Taiwanna Granae Brown-bolds | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1619062338 | Elizabeth Dykes Degive | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1336234053 | John Manor Entrekin | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| 1245325968 | Debora Ann Goodrich | Internal Medicine | 1301 Well Brook Circle, Conyers, GA 30012-3873 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578188306 | The Eye Md | Ophthalmology | 1359 Milstead Road, Suite #103, Conyers, GA 30012 | 2020-06-08 |
| 1043855836 | Maurvet Minto | Counselor | 1175 Green St, Conyers, Conyers, GA 30012 | 2019-11-15 |
| 1770054561 | Sarah Elizabeth Brooks | Physical Medicine & Rehabilitation | 1290 Milstead Ave Ne, Conyers, GA 30012 | 2018-12-06 |
| 1679091276 | Valorie Antoinette Jones | Counselor | 1175 Green St Se, Conyers, GA 30012 | 2017-09-02 |
| 1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
| 1558813295 | Salon Lyon, LLC | Specialist | 1112 West Ave, Se, B, Conyers, GA 30012 | 2016-10-28 |
| 1992252753 | Traci Hunter Bryan | Pharmacist | 1501 Milstead Ave Ne, Suite 110, Conyers, GA 30012 | 2016-09-08 |
| 1316491830 | Hye Rim Kim | Anesthesiologist Assistant | 1380 Milstead Rd Ne, Suite G, Conyers, GA 30012 | 2016-08-12 |
| 1235591397 | David Jeffrey Wasserman | Optometrist | 1192 Dogwood Dr Sw, Conyers, GA 30012 | 2016-03-28 |
| 1174919187 | Anique Archer | Health Educator | 2170 Lester Rd Nw, Conyers, GA 30012 | 2015-04-07 |
| Find all providers in zip 30012 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
| 1134383565 | Eastern Health Center PC | General Practice | 1455 Old Mcdonough Hwy #c, Conyers, GA 30094 | 2008-07-15 |
| 1649210006 | Sollage Pain Solutions of Georgia | General Practice | 1701 Ellington Rd Se, Suite B, Conyers, GA 30013-2192 | 2006-06-07 |
| 1285814491 | Darryl S Gross Md PC | General Practice | 2280 Salem Rd Se, Suite 102, Conyers, GA 30013-2003 | 2007-11-06 |
| 1306844675 | Mary Jane B Kassam | General Practice | 2020 Honey Creek Pkwy Se, Conyers, GA 30013-2974 | 2005-07-12 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.