Healthcare Provider Details

I. General information

NPI: 1205095148
Provider Name (Legal Business Name): COMMERCE ADULT MEDICINE AND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 02/28/2012
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 TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number053646
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053614
License Number StateGA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ADOLFO RANDOLPH SUAREZ
Title or Position: OWNER
Credential: MD
Phone: 706-335-7909