1326221698 NPI number — PAOLA JULIANA SUAREZ M.D.

Table of content: EMILY GLOSS MS (NPI 1730513250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326221698 NPI number — PAOLA JULIANA SUAREZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUAREZ
Provider First Name:
PAOLA
Provider Middle Name:
JULIANA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326221698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUMMING
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30040-2467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-887-1668
Provider Business Mailing Address Fax Number:
770-887-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 OAKSIDE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-6413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-807-1050
Provider Business Practice Location Address Fax Number:
678-807-1055
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  67096 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: 19949 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 300022400A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00313120097 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C02394 . This is a "MEDICARE GROUP" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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