Provider Demographics
NPI:1205095148
Name:COMMERCE ADULT MEDICINE AND PEDIATRICS
Entity type:Organization
Organization Name:COMMERCE ADULT MEDICINE AND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-335-7909
Mailing Address - Street 1:687 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1146
Mailing Address - Country:US
Mailing Address - Phone:706-335-7909
Mailing Address - Fax:
Practice Address - Street 1:687 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1146
Practice Address - Country:US
Practice Address - Phone:706-335-7909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053646208000000X
GA053614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty