Healthcare Provider Details

I. General information

NPI: 1144314105
Provider Name (Legal Business Name): JOANNA HEARD SUAREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

687 HOSPITAL RD
COMMERCE GA
30529-1146
US

IV. Provider business mailing address

687 HOSPITAL RD
COMMERCE GA
30529-1146
US

V. Phone/Fax

Practice location:
  • Phone: 706-335-7909
  • Fax:
Mailing address:
  • Phone: 706-335-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number053646
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier852242010D
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: