Provider Demographics
NPI:1417449695
Name:SUDA, ALEXANDER CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHRISTIAN
Last Name:SUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-848-5300
Mailing Address - Fax:843-848-5395
Practice Address - Street 1:GEORGETOWN PHYSICIAN ASSOCIATES, LLC
Practice Address - Street 2:2200 CROW LANE, STE 301
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577
Practice Address - Country:US
Practice Address - Phone:843-848-5300
Practice Address - Fax:843-848-5305
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-04
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52233207Q00000X
SCLL52233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty