Healthcare Provider Details

I. General information

NPI: 1427353861
Provider Name (Legal Business Name): SUWANEE PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2011
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 PEACHFORD RD HOSPITALIST SERVICE
ATLANTA GA
30338-6534
US

IV. Provider business mailing address

4905 WINDING ROSE DR
SUWANEE GA
30024-3074
US

V. Phone/Fax

Practice location:
  • Phone: 770-313-2034
  • Fax:
Mailing address:
  • Phone: 678-889-4880
  • Fax: 678-889-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number45885
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number45885
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM MCMAHON
Title or Position: OWNER, PHYSICIAN
Credential: M.D.
Phone: 678-889-4880