Individual
CHRISTINE SUTANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1459 LANEY WALKER BLVD, AUGUSTA, GA 30912-0002
(706) 721-7005
Mailing address
636 11TH ST APT 2109, AUGUSTA, GA 30901-2186
(213) 369-0199
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
16476
GA
Other
Enumeration date
06/06/2024
Last updated
06/06/2024
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