MEDICARE: AMOD O SUREKA M.D.

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	208100000X	Physical Medicine & Rehabilitation Physician	077948	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548291750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMOD O SUREKA M.D.

Provider Business Mailing Address
First Line	:	2675 N DECATUR RD STE 110
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	770-979-8080
Fax Number	:	770-979-8099

Provider Business Practice Location Address
First Line	:	2675 N DECATUR RD STE 110
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6130
Country	:	US
Telephone Number	:	770-979-8080
Fax Number	:	770-979-8099

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/21/2022

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Directions to “ AMOD O SUREKA M.D.” Practice Location

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