Doctor Name: | DR. SUSAN SUTPHEN |
NPI Number: | 1083868939 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | |
Business Practice Address: | 6760 Jimmy Carter Blvd Suite 150 Norcross, GA - 300711278 |
Business Phone Number: | 6788922000 |
Business Fax Number: | |
Mailing Address: | 791 Oak St, HAPEVILLE |
State: | GA |
Postal Code: | 303541748 |
Phone Number: | 4046012000 |
Fax Number: | 4045590257 |
NPI Enumeration Date: | 11/05/2008 |
NPI Last Update Date: | 11/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |