Provider Demographics
NPI:1720060668
Name:SANUSI, H DAVID (MD)
Entity Type:Individual
Prefix:
First Name:H DAVID
Middle Name:
Last Name:SANUSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HANI
Other - Middle Name:DAVID
Other - Last Name:SANUSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 DALLAS HWY
Mailing Address - Street 2:PMB 160 STE 202
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-7505
Mailing Address - Country:US
Mailing Address - Phone:770-920-6413
Mailing Address - Fax:678-974-3113
Practice Address - Street 1:2500 DALLAS HWY
Practice Address - Street 2:PMB 160 STE 202
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-7505
Practice Address - Country:US
Practice Address - Phone:770-920-6413
Practice Address - Fax:678-974-3113
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036450207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000573185DMedicaid
GA000573185FMedicaid
GA491431789AMedicaid
GA05BDJVRMedicare PIN
GA000573185FMedicaid
GAGRP6182Medicare PIN