Provider Demographics
NPI:1447457817
Name:SUJI, PAUL I (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:I
Last Name:SUJI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3071 WOODWALK DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-8551
Mailing Address - Country:US
Mailing Address - Phone:404-233-9296
Mailing Address - Fax:404-841-9908
Practice Address - Street 1:3393 PEACHTREE RD NE
Practice Address - Street 2:SUITE B 128
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1162
Practice Address - Country:US
Practice Address - Phone:404-233-9296
Practice Address - Fax:404-841-9908
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002386OtherSTATE LICENSE
GA793589733AMedicaid
GA45593OtherAVESIS
GA002386OtherSTATE LICENSE
GA793589733AMedicaid