Individual provider Active NPI

Sushma Sudhi, DO

  • Pediatrics Physician
  • Carrollton, GA
National Provider Identifier
1770045015
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
91782 Issued in GA
Practice address
706 Dixie St Ste 210
Carrollton, GA 30117-3889
Phone
(770) 812-8640
Fax
(770) 838-8650
NPI assigned
Apr 4, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 91782 GA Primary

Addresses

Primary practice location

706 Dixie St Ste 210
Carrollton, GA 30117-3889

Mailing address

706 Dixie St Ste 210
Carrollton, GA 30117-3889
Phone (770) 812-8640

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240219002366 GA Practitioner - Pediatric Medicine 8820432784 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Pediatrics CurrentSince Jan 14, 2024 Accepting new patients
Pediatrix Medical Group of Georgia, P.C. Past Accepting new patients
TMC Children'S Healthcare of West Georgia PastSince May 29, 2022 Accepting new patients

Locations

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

706 Dixie St
Ste 220
Carrollton, GA 30117
Phone (770) 812-8825

706 Dixie St
Ste 210
Carrollton, GA 30117
Phone (770) 812-8640

100 Greenway Blvd
Fl 2
Carrollton, GA 30117
Phone (770) 838-8710

601 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 456-3000

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1770045015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 DIXIE ST STE 210",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173889",
            "telephone_number": "770-812-8640",
            "fax_number": "770-838-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 DIXIE ST STE 210",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173889",
            "telephone_number": "770-812-8640",
            "fax_number": "770-838-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUDHI",
        "first_name": "SUSHMA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "91782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.