Provider Demographics
NPI:1962466888
Name:SUSSMAN, HY CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:HY
Middle Name:CHARLES
Last Name:SUSSMAN
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:PO BOX 3448
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3448
Mailing Address - Country:US
Mailing Address - Phone:706-737-6557
Mailing Address - Fax:706-733-2229
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2629
Practice Address - Country:US
Practice Address - Phone:706-737-6557
Practice Address - Fax:706-733-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009271207RN0300X
SC6890207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC903035Medicaid
SC4232266OtherAETNA PROVIDER NUMBER
GA00020039LMedicaid
SC043723466OtherTRICARE
SCGPA743Medicaid
SCD421617503Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SC903035Medicaid
SCD421610281Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
SCGPA743Medicaid
D42161Medicare UPIN
SC390008621Medicare ID - Type UnspecifiedRAILROAD PROVIDER NUMBER
SC110082149Medicare ID - Type UnspecifiedRAILROAD PROVIDER NUMBER