SUSAN GAIL STAVISS M.D. NPI 1346242229

NPI Information

NPI: 1346242229
Provider Name: SUSAN GAIL STAVISS, M.D.
Classification: Pediatrics - 2080A0000X
Entity Type: Individual

Specialization: Adolescent Medicine

PECOS Registration: Yes

Address:
3939 ROSWELL RD
SUITE 300
MARIETTA, GA
ZIP 30062
Phone: (770) 578-2868
Get Directions

Susan Gail Staviss, M.D. is an adolescent medicine pediatrics in Marietta, GA. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. Susan Gail Staviss, M.D. NPI is 1346242229. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3939 ROSWELL RD
SUITE 300
MARIETTA, GA
ZIP 30062-251
Phone: (770) 578-2868
Fax: (770) 971-8499

The NPI 1346242229 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/11/2005 and was last updated on 10/2/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	038652	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	3308662027	OTHER	GEORGIA	CIGNA
2	000607703D	MEDICAID	GEORGIA
3	241020	OTHER	GEORGIA	PRIVATE HEALTHCARE SYSTEM
4	4508167	OTHER	GEORGIA	AETNA USHEALTHCARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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