Provider Demographics
NPI:1861043275
Name:SUSLIN, IGOR A (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:A
Last Name:SUSLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4775 BUFORD HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3722
Mailing Address - Country:US
Mailing Address - Phone:404-921-5999
Mailing Address - Fax:404-855-4152
Practice Address - Street 1:4775 BUFORD HWY STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3722
Practice Address - Country:US
Practice Address - Phone:404-921-5999
Practice Address - Fax:404-855-4152
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZC0007X, 390200000X
GA89964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program