Provider Demographics
NPI:1386875862
Name:SMITH, SUNCERERAE NATEL (CFA)
Entity type:Individual
Prefix:
First Name:SUNCERERAE
Middle Name:NATEL
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFA
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 768138
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-8138
Mailing Address - Country:US
Mailing Address - Phone:770-559-0721
Mailing Address - Fax:770-559-0639
Practice Address - Street 1:512 WYNFIELD TRCE
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-4554
Practice Address - Country:US
Practice Address - Phone:770-559-0721
Practice Address - Fax:770-559-0639
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2009-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115523363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical