SUSAN GAIL STAVISS M.D. NPI 1346242229

NPI Information

  • NPI: 1346242229
  • Provider Name: SUSAN GAIL STAVISS, M.D.
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 3939 ROSWELL RD
    SUITE 300
    MARIETTA, GA
    ZIP 30062
  • Phone: (770) 578-2868

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NPI Details

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
12080A0000XPediatricsAdolescent Medicine038652GEORGIAYes

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
13308662027OTHERGEORGIACIGNA
2000607703DMEDICAIDGEORGIA
3241020OTHERGEORGIAPRIVATE HEALTHCARE SYSTEM
44508167OTHERGEORGIAAETNA 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: 11/21/2025

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