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NPI Code Detail

MEDICARE: DR. SUSAMMA MATHEW MD

MEDICARE: DR. SUSAMMA MATHEW 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
1174400000XSpecialist045881GA

Other Identifiers

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

General Provider Information

NPI Number : 1942209259
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAMMA MATHEW MD
Provider Business Mailing Address
First Line : 3525 SUGARLOAF PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5403
Country : US
Telephone Number : 678-377-1113
Fax Number : 678-377-9390
Provider Business Practice Location Address
First Line : 3525 SUGARLOAF PKWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-5403
Country : US
Telephone Number : 678-377-1113
Fax Number : 678-377-9390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 02/23/2011

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