Organization
HY C SUSSMAN MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HY CHARLES SUSSMAN MD (OWNER)
(706) 737-6557
Entity
Organization
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2629
(706) 737-6557
(706) 733-2229
Mailing address
PO BOX 3448, AUGUSTA, GA 30914-3448
(706) 737-6557
(706) 733-2229
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
009271
GA
207RN0300X
Nephrology Physician
6890
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000020039L
—
GA
01
—
GPA743
MEDICAID
SC
Enumeration date
10/10/2006
Last updated
02/03/2010
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