Provider Demographics
NPI:1851387310
Name:SUDDUTH, COLEMAN DAVID JR (MD)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:DAVID
Last Name:SUDDUTH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5504
Mailing Address - Fax:912-466-5593
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:SUITE 504
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5504
Practice Address - Fax:912-466-5593
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA031841207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000500772DMedicaid
GA290015437OtherRAILROAD MEDICARE
GAF33510Medicare UPIN
GA000500772DMedicaid