Active NPI
Shannon Su
- Plastic Surgery Physician
- Atlanta, GA
National Provider Identifier
1235701442
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- PTL19410
- Practice address
- 100 Woodruff Cir NE Ste P375
Atlanta, GA 30322-1020 - Phone
- (404) 727-5655
- NPI assigned
- Jul 15, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | PTL19410 | CA | Primary |
Addresses
Primary practice location
100 Woodruff Cir NE Ste P375
Atlanta, GA 30322-1020
Mailing address
1600 Divisadero St RM H2907
San Francisco, CA 94143-3010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251118004886 | CA | Order and Referring Only - Plastic and Reconstructive Surgery | 4486145364 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL19410 | CA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626307200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1759968000000",
"number": "1235701442",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 DIVISADERO ST RM H2907",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941433010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 WOODRUFF CIR NE STE P375",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303221020",
"telephone_number": "404-727-5655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SU",
"first_name": "SHANNON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-15",
"last_updated": "2025-10-09",
"certification_date": "2025-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "PTL19410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.