Provider Demographics
NPI:1992769467
Name:SURANIE, DEREK JOHN (MED,ATC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:JOHN
Last Name:SURANIE
Suffix:
Gender:M
Credentials:MED,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 ADMIRALS POINTE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8667
Mailing Address - Country:US
Mailing Address - Phone:678-947-1282
Mailing Address - Fax:706-867-2865
Practice Address - Street 1:130 GEORGIA CIRCLE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30597-0001
Practice Address - Country:US
Practice Address - Phone:706-867-2770
Practice Address - Fax:706-867-2865
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0006062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer