Provider Demographics
NPI:1841304268
Name:SUHOLET, DAVID WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:SUHOLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2751 BUFORD HWY NE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3207
Mailing Address - Country:US
Mailing Address - Phone:404-325-0100
Mailing Address - Fax:404-237-9050
Practice Address - Street 1:2751 BUFORD HWY NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3207
Practice Address - Country:US
Practice Address - Phone:404-325-0100
Practice Address - Fax:404-237-9050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0466532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA733722881AMedicaid
H26851Medicare UPIN