Individual
DR. SUSAMMA MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3525 SUGARLOAF PKWY, LAWRENCEVILLE, GA 30044-5403
(678) 377-1113
(678) 377-9390
Mailing address
3525 SUGARLOAF PKWY, LAWRENCEVILLE, GA 30044-5403
(678) 377-1113
(678) 377-9390
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
045881
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00797057B
—
GA
Enumeration date
07/19/2005
Last updated
02/23/2011
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