Provider Demographics
NPI:1740263391
Name:MARGLETTA, SUSAN CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:MARGLETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3941 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2207
Mailing Address - Country:US
Mailing Address - Phone:770-582-1911
Mailing Address - Fax:770-582-1942
Practice Address - Street 1:3941 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2207
Practice Address - Country:US
Practice Address - Phone:770-582-1911
Practice Address - Fax:770-582-1942
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2010-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA038044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00618527BMedicaid
GA00618527BMedicaid
F55408Medicare UPIN