# CHAMBLEE MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOREN S THOMAS MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609820745
- **Authorized official:** SOREN THOMAS (OWNER)
- **Authorized official phone:** (770) 458-0025

## Contact information

- **Practice address:** 3739 CHAMBLEE DUNWOODY RD, CHAMBLEE, GA 30341-2062
- **Practice address phone:** (770) 458-0025
- **Practice address fax:** (770) 458-0807
- **Mailing address:** PO BOX 80042, ATLANTA, GA 30366-0042

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 026895 | GA | Yes |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 02/25/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1154284 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |