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General NPI Number Information
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NPI Number | 1407834161
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Entity Type | Individual
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Provider Name | STEPHEN JOHN SUSS MD
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1478 DOGWOOD DRIVE, SE, SUITES B & C KAISER PERMANENTE CONYERS MEDICAL CENTER
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City | CONYERS
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State | GA
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Zip | 30013
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Country | US
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Telephone | 678-413-4320
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Fax | 706-865-6268
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Provider Business Mailing Address
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Address Line | 3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 404-364-7070
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Fax | 706-865-6268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-033938-E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 054679
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License Number State | GA
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