Healthcare Provider Details

I. General information

NPI: 1609196872
Provider Name (Legal Business Name): ADAM M SUNDERLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DALLAS HWY STE 301
VILLA RICA GA
30180
US

IV. Provider business mailing address

150 CLINIC AVE STE 101
CARROLLTON GA
30117-4402
US

V. Phone/Fax

Practice location:
  • Phone: 770-456-0211
  • Fax:
Mailing address:
  • Phone: 770-834-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number073845
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number073845
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: