Provider Demographics
NPI:1407834161
Name:SUSS, STEPHEN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:SUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S.
Other - Middle Name:JOHN
Other - Last Name:SUSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:706-865-6268
Practice Address - Street 1:1478 DOGWOOD DRIVE, SE, SUITES B & C
Practice Address - Street 2:KAISER PERMANENTE CONYERS MEDICAL CENTER
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013
Practice Address - Country:US
Practice Address - Phone:678-413-4320
Practice Address - Fax:706-865-6268
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-033938-E207Q00000X
GA054679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACN0368OtherRR MEDICARE GROUP
GAHOSP60OtherMEDICARE GROUP
GA015953OtherBCBS
GA195109401AMedicaid
GAP00146364OtherRR MEDICARE
GA197753376Medicaid
GA10063293OtherAMERIGROUP
GA336284OtherWELLCARE
GAHOSP60OtherMEDICARE GROUP
GA197753376Medicaid