Staviss, Susan Gail

Staviss, Susan Gail is an individual health care provider with primary practice located at 3939 Roswell Rd Suite 300, Marietta GA 30062-6251. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as her primary health care specialty. Staviss, Susan Gail can be contacted via phone (770) 578-2868.

Contact Information

Primary practice address
3939 Roswell Rd Suite 300 Marietta GA 30062-6251
Phone: (770) 578-2868
Fax: (770) 971-8499
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 038652 Georgia

Profile Details

NPI number 1346242229
LBN Legal business name Staviss, Susan Gail
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 11th, 2005
Last updated Oct 2nd, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346242229 NPPES
Georgia MEDICAID 000607703D
Georgia Other 241020
Georgia Other 4508167
Georgia Other 3308662027

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