Basic Information
| Provider Information | |||||||||
| NPI: | 1770719650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SULEIMAN | ||||||||
| FirstName: | MOYOSORE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782890549 | ||||||||
| FaxNumber: | 6782898756 | ||||||||
| Practice Location | |||||||||
| Address1: | 1045 SOUTHCREST DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302816113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782890549 | ||||||||
| FaxNumber: | 6782898756 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 08/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 036122623 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 063204 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RH0003X | 063204 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | G07436A | 01 | GA | MEDICARE PTAN | OTHER | 385795321P | 05 | GA | MEDICAID | 385795321O | 05 | GA | MEDICAID |