Suraj Sukumaran, MD
Individual provider Active NPI Pediatrics Physician · Louisville, GA
NPI 1861408007 · NPPES record last updated Sep 22, 2020
Key facts
- NPI
- 1861408007
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 044598 (GA)
- Practice address
- 1067 Peachtree St
Louisville, GA 30434-1558 - Phone
- (478) 625-7000
- Fax
- (478) 625-8907
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044598 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients | |
| Hospital Authority of Jefferson County and the City of Louisville | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 044598 | GA | Yes |
Addresses
Primary practice location
1067 Peachtree St
Louisville, GA 30434-1558
Mailing address
1067 Peachtree St
Louisville, GA 30434-1558
Phone (478) 625-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000800357A | Medicaid | GA |
Other providers in Louisville, GA
- Rai Care Centers of Georgia I LLC
- Catherine Mary Russell
- Tyrek S Scott
- Southcare Medical Center
- Rhonda Hall Strickland
- Jennifer Hadden Tanner
- The Louisville Project, LLC
- The Louisville Project, LLC
- Tonya M Gunby DMD PC
- United Rehab Inc
All providers in Louisville, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.