Provider Demographics
NPI:1275911828
Name:SUMAILI, ST CLAIRE GITAU (MD)
Entity Type:Individual
Prefix:
First Name:ST CLAIRE
Middle Name:GITAU
Last Name:SUMAILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ST CLAIRE
Other - Middle Name:
Other - Last Name:SUMAILI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2403 OSLER CT STE A
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0205
Mailing Address - Country:US
Mailing Address - Phone:229-405-6196
Mailing Address - Fax:229-261-1334
Practice Address - Street 1:2403 OSLER CT STE A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0205
Practice Address - Country:US
Practice Address - Phone:229-405-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine