Individual
HANNA SORG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3535 SOUTHERN BLVD, KETTERING, OH 45429-1221
(937) 436-4658
Mailing address
3131 NEWMARK DR STE 220, MIAMISBURG, OH 45342-5400
(937) 436-4658
(937) 436-4984
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004479
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145021
—
OH
Enumeration date
09/21/2015
Last updated
05/06/2020
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