Provider Demographics
NPI:1962422030
Name:SU, JOHNNY G (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:G
Last Name:SU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:ARTHRITIS CLINIC OF STARK COUNTY
Mailing Address - Street 2:4160 HOLIDAY ST NW
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-492-4966
Mailing Address - Fax:330-492-9344
Practice Address - Street 1:231 SEASONS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:330-662-5667
Practice Address - Fax:330-255-5081
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-08-14
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Provider Licenses
StateLicense IDTaxonomies
OH35.084920207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2495858Medicaid
OH2495858Medicaid
OHP00144136OtherRAILROAD MEDICARE
OH364061OtherWELLCARE
OH7010610OtherAETNA
OH735670OtherBUCKEYE
OH000000224471OtherUNISON
OH2495858Medicaid
SU4142025Medicare PIN
OHP00478436Medicare PIN
OH7010610OtherAETNA