Provider Demographics
NPI:1043401326
Name:SUMMITRIDGE
Entity Type:Organization
Organization Name:SUMMITRIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSESSMENT COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-312-5850
Mailing Address - Street 1:250 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5675
Mailing Address - Country:US
Mailing Address - Phone:678-312-5850
Mailing Address - Fax:678-312-5915
Practice Address - Street 1:250 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-5675
Practice Address - Country:US
Practice Address - Phone:678-312-5850
Practice Address - Fax:678-312-5915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNETT HEALTH SYSTEMS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004523282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital