Basic Information
Provider Information | |||||||||
NPI: | 1598709487 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CHIN | ||||||||
FirstName: | SUZETTE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 21 POINTE NORTH DR | ||||||||
Address2: |   | ||||||||
City: | CARTERSVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 301207952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6787210705 | ||||||||
FaxNumber: | 6787215116 | ||||||||
Practice Location | |||||||||
Address1: | 21 POINTE NORTH DR | ||||||||
Address2: |   | ||||||||
City: | CARTERSVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 301207911 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6787210705 | ||||||||
FaxNumber: | 6787215116 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/15/2006 | ||||||||
LastUpdateDate: | 06/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 058955 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | GA058955 | GA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 270319073A | 05 | GA |   | MEDICAID | 270319073C | 05 | GA |   | MEDICAID | 270319073E | 05 | GA |   | MEDICAID | 270319073B | 05 | GA |   | MEDICAID | 270319073D | 05 | GA |   | MEDICAID |