Individual
MS. SUJI V MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(770) 400-6620
(770) 400-6833
Mailing address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(770) 400-6620
(770) 400-6833
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
026119
AL
207RI0200X
Infectious Disease Physician
Primary
062557
GA
208M00000X
Hospitalist Physician
26119
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109053
—
AL
05
—
1912920356
—
AL
01
—
51597449
BCBS
AL
Enumeration date
07/26/2006
Last updated
06/24/2021
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