Kenneth M Sussman, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

050757 Issued in GA

Practice address

768 Glen Valley Way
Dacula, GA 30019-4878

Phone

(770) 513-3990

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1194888065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "768 GLEN VALLEY WAY",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194878",
            "telephone_number": "770-513-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 GLEN VALLEY WAY",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300194878",
            "telephone_number": "770-513-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUSSMAN",
        "first_name": "KENNETH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "050757",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Freda Vonzelle Still, DNP, APRN, PMHNP-BC
• Billy Stone
• Linda Marie Stringer, DMD
• Zhuocheng Su, DO
• Shashvat Sukhal, M.D.
• Cathy Sutton, LCSW
• Brian Swierczek
• Mattea Sykes, OTR/L
• Grace Tabazi
• Samia Tahil, HHC

• Obstetrics & Gynecology Physician in Dacula, GA
• Providers in Dacula, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.