Healthcare Provider Details

I. General information

NPI: 1215355425
Provider Name (Legal Business Name): SE YOUNG SUH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 POINTE PL
ROSWELL GA
30076-4636
US

IV. Provider business mailing address

11731 POINTE PL
ROSWELL GA
30076-4636
US

V. Phone/Fax

Practice location:
  • Phone: 770-284-3150
  • Fax: 770-284-3170
Mailing address:
  • Phone: 770-284-3150
  • Fax: 770-284-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number109507
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: