Healthcare Provider Details

I. General information

NPI: 1306026307
Provider Name (Legal Business Name): SUWANEE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-1995
US

IV. Provider business mailing address

960 PEACHTREE INDUSTRIAL BLVD
SUWANEE GA
30024-1995
US

V. Phone/Fax

Practice location:
  • Phone: 770-831-8191
  • Fax:
Mailing address:
  • Phone: 770-831-8191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN Y SHIH
Title or Position: PRESIDENT
Credential: D.O.
Phone: 770-831-8191