Individual provider Active NPI

Suzanne H Gudakunst, DC

  • Rehabilitation Chiropractor
  • Roswell, GA
National Provider Identifier
1578618898
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
CHIRO007176 Issued in GA
Practice address
415 E Crossville Rd
Suite B
Roswell, GA 30075-3037
Phone
(770) 645-9595
NPI assigned
Jan 25, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X CHIRO007176 GA Primary

Addresses

Primary practice location

415 E Crossville Rd
Suite B
Roswell, GA 30075-3037

Mailing address

415 E Crossville Rd
Suite B
Roswell, GA 30075-3037
Phone (770) 645-9595

Other identifiers 1

IdentifierTypeStateIssuer
CHIR007176OtherGASTATE OF GEORGIA LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
CHIRO007176GAMDRehabilitation Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Care Group Rehabilitation Past Accepting new patients
Pinnacle Care Group LLC Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1578618898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E CROSSVILLE RD",
            "address_2": "SUITE B",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753037",
            "telephone_number": "770-645-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E CROSSVILLE RD",
            "address_2": "SUITE B",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753037",
            "telephone_number": "770-645-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDAKUNST",
        "first_name": "SUZANNE",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "GA",
            "license": "CHIRO007176",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF GEORGIA LICENSE",
            "identifier": "CHIR007176",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.