Provider Demographics
NPI:1104855949
Name:MOOLE, SUMANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMANA
Middle Name:
Last Name:MOOLE
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 1:3390 PADDOCKS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9119
Mailing Address - Country:US
Mailing Address - Phone:770-400-0828
Mailing Address - Fax:866-554-1774
Practice Address - Street 1:3390 PADDOCKS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9119
Practice Address - Country:US
Practice Address - Phone:770-400-0828
Practice Address - Fax:866-554-1774
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77681207RG0100X
FLME117040207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009420200Medicaid
FL14R7EOtherBLUE CROSS BLUE SHIELD
FL14R7EOtherBLUE CROSS BLUE SHIELD
I45877Medicare UPIN