Healthcare Provider Details

I. General information

NPI: 1346425931
Provider Name (Legal Business Name): WAYNE G SUWAY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 THE EXCHANGE SUITE 600
ATLANTA GA
30339-2083
US

IV. Provider business mailing address

1820 THE EXCHANGE SUITE 600
ATLANTA GA
30339-2083
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-1752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9110
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: