Provider Demographics
NPI:1255483111
Name:SUGARLOAF MEDICAL P.C.
Entity Type:Organization
Organization Name:SUGARLOAF MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHUKRI
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MAKHLOUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-713-8663
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:UNIT 4203
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4539
Mailing Address - Country:US
Mailing Address - Phone:770-831-3018
Mailing Address - Fax:770-831-3669
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:UNIT 4203
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4539
Practice Address - Country:US
Practice Address - Phone:770-831-3018
Practice Address - Fax:770-831-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty