MEDICARE: DR. SHUBORNA BONNIE NATH SUWAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	90723	SC

General Provider Information

NPI Number	:	1376163048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHUBORNA BONNIE NATH SUWAN MD

Provider Business Mailing Address
First Line	:	300 E HOSPITAL RD
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 E HOSPITAL RD
Second Line	:
City	:	FORT EISENHOWER
State	:	GA
Zip	:	30905-0000
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	09/11/2025

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