MEDICARE: SHANDRA SUTTON

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1568328185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANDRA SUTTON

Provider Business Mailing Address
First Line	:	50 LENOX POINTE NE
Second Line	:	SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:	678-824-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 LENOX POINTE NE
Second Line	:	SUITE A
City	:	ATLANTA
State	:	GA
Zip	:	30324
Country	:	US
Telephone Number	:	678-824-6590
Fax Number	:

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

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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