Healthcare Provider Details

I. General information

NPI: 1891793139
Provider Name (Legal Business Name): LADDEUS L SUTTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 COURT DR STE 200
GASTONIA NC
28054-2178
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-868-3256
  • Fax: 704-868-5870
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9300332
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: