Provider Demographics
NPI:1346225919
Name:STOREY, SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:STOREY
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 1:611 E VILLANOW ST
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2618
Mailing Address - Country:US
Mailing Address - Phone:706-638-1606
Mailing Address - Fax:706-638-9987
Practice Address - Street 1:611 E VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2618
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-638-9987
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000903207DMedicaid
GA000903207DMedicaid
TN3891920Medicare PIN