Provider Demographics
NPI:1023294196
Name:SUBURBAN MEDICAL ASSOCI
Entity type:Organization
Organization Name:SUBURBAN MEDICAL ASSOCI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-740-8550
Mailing Address - Street 1:3005 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8594
Mailing Address - Country:US
Mailing Address - Phone:770-740-8550
Mailing Address - Fax:770-740-9338
Practice Address - Street 1:3005 OLD ALABAMA RD
Practice Address - Street 2:SUITE 230
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-8594
Practice Address - Country:US
Practice Address - Phone:770-740-8550
Practice Address - Fax:770-740-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1023294196Medicare PIN