Provider Demographics
NPI:1912920356
Name:MATHEW, SUJI V (MD)
Entity Type:Individual
Prefix:MS
First Name:SUJI
Middle Name:V
Last Name:MATHEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 CELEBRATE LIFE PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-8001
Mailing Address - Country:US
Mailing Address - Phone:770-400-6620
Mailing Address - Fax:770-400-6833
Practice Address - Street 1:600 CELEBRATE LIFE PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8001
Practice Address - Country:US
Practice Address - Phone:770-400-6620
Practice Address - Fax:770-400-6833
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL026119174400000X
AL26119208M00000X
GA062557207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1912920356Medicaid
AL109053Medicaid
AL51597449OtherBCBS
AL510I110426Medicare PIN