Individual
KENNETH JAY SOBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
575 PROFESSIONAL DR, STE 510, LAWRENCEVILLE, GA 30045-3336
(770) 513-2072
(770) 513-7986
Mailing address
575 PROFESSIONAL DR, STE 510, LAWRENCEVILLE, GA 30045-3336
(770) 513-2072
(770) 513-7986
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
024099
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000435949B
—
GA
01
—
110064877
PALMETTO
GA
01
—
52067326
BCBSGA
GA
01
—
581854158
UHC,HUMANA, CIGNA
GA
01
—
581854158001
TRICARE
GA
01
—
E00581854158
AETNA
GA
Enumeration date
06/22/2005
Last updated
09/15/2020
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