Individual
JEFFREY EDWARD SOOTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 TREE LANE RD, SUITE 330, SNELLVILLE, GA 30078-4700
(770) 978-0561
(770) 978-0546
Mailing address
1800 TREE LANE RD, SUITE 330, SNELLVILLE, GA 30078-4700
(770) 978-0561
(770) 978-0546
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
048942
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000880591C
—
GA
05
—
00880591A
—
GA
01
—
020047989
RAILROAD MEDICARE
GA
Enumeration date
08/12/2005
Last updated
11/01/2007
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