Provider Demographics
NPI:1063470896
Name:CLARKE, SUZANNE DIMPLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:DIMPLE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0015
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:1263 MORELAND AVE SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3183
Practice Address - Country:US
Practice Address - Phone:470-444-3137
Practice Address - Fax:470-202-3003
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA057446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG83539Medicare UPIN