Provider Demographics
NPI:1487614574
Name:SMITH, SUZANNE PATRICE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PATRICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116470
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6470
Mailing Address - Country:US
Mailing Address - Phone:770-682-2080
Mailing Address - Fax:678-579-9398
Practice Address - Street 1:1293 WELLBROOK CIR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3873
Practice Address - Country:US
Practice Address - Phone:770-922-2012
Practice Address - Fax:770-922-8370
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA488242085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900556FMedicaid
GAH33660Medicare UPIN
GA92BBFQGMedicare ID - Type Unspecified