Healthcare Provider Details

I. General information

NPI: 1023506557
Provider Name (Legal Business Name): JAMES SU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE STE D112
ATLANTA GA
30322
US

IV. Provider business mailing address

PO BOX 200096
CARTERSVILLE GA
30120-9002
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5287
  • Fax:
Mailing address:
  • Phone: 770-607-7339
  • Fax: 678-905-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number11495
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number95571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: