Provider Demographics
NPI:1083868939
Name:SUTPHEN, SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SUTPHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1748
Mailing Address - Country:US
Mailing Address - Phone:404-601-2000
Mailing Address - Fax:404-559-0257
Practice Address - Street 1:6760 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1278
Practice Address - Country:US
Practice Address - Phone:678-892-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA037396OtherGEOGIA MEDICAL LICENSE