Individual
DR. SOREN KNUDSEN ESTVOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD MPH CAQSM
Contact information
Practice address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(706) 721-3159
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
11978
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
94989
GA
Other
Enumeration date
06/11/2020
Last updated
06/17/2025
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