Healthcare Provider Details

I. General information

NPI: 1326221698
Provider Name (Legal Business Name): PAOLA JULIANA SUAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 OAKSIDE LN
CANTON GA
30114-6413
US

IV. Provider business mailing address

260 ELM ST
CUMMING GA
30040-2467
US

V. Phone/Fax

Practice location:
  • Phone: 678-807-1050
  • Fax: 678-807-1055
Mailing address:
  • Phone: 770-887-1668
  • Fax: 770-887-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67096
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19949
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: