Provider Demographics
NPI:1245881515
Name:WAYNE G SUWAY D.D.S., PC
Entity type:Organization
Organization Name:WAYNE G SUWAY D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:SUWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-953-1752
Mailing Address - Street 1:1820 THE EXCHANGE SE STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2083
Mailing Address - Country:US
Mailing Address - Phone:770-953-1752
Mailing Address - Fax:770-953-6470
Practice Address - Street 1:1820 THE EXCHANGE SE STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2083
Practice Address - Country:US
Practice Address - Phone:770-953-1752
Practice Address - Fax:770-953-6470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental