Provider Demographics
NPI:1730133646
Name:KOVACS, SUZANNE DENISE (MD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:DENISE
Last Name:KOVACS
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4123
Mailing Address - Fax:
Practice Address - Street 1:1650 SKYLYN DR STE 220
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1069
Practice Address - Country:US
Practice Address - Phone:864-560-9056
Practice Address - Fax:864-560-9057
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00386924OtherMEDICARE RAILROAD PTAN#
SC110178290OtherRAILROAD MEDICARE
SCSC37125019OtherMEDICARE PIN
SC202426Medicaid
SC110178290OtherRAILROAD MEDICARE
SCSC37125019Medicare PIN
SC5878670017Medicare NSC