Provider Demographics
NPI:1306026307
Name:SUWANEE MEDICAL CENTER
Entity Type:Organization
Organization Name:SUWANEE MEDICAL CENTER
Other - Org Name:SUWANEE FAMILY PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-831-8191
Mailing Address - Street 1:960 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1995
Mailing Address - Country:US
Mailing Address - Phone:770-831-8191
Mailing Address - Fax:
Practice Address - Street 1:960 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1995
Practice Address - Country:US
Practice Address - Phone:770-831-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3910Medicare PIN