Provider Demographics
NPI:1871160382
Name:ROCHA, SUZANA KELY (MD)
Entity type:Individual
Prefix:
First Name:SUZANA
Middle Name:KELY
Last Name:ROCHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 12TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-6976
Mailing Address - Country:US
Mailing Address - Phone:229-444-3874
Mailing Address - Fax:
Practice Address - Street 1:114 12TH ST W STE A
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-6976
Practice Address - Country:US
Practice Address - Phone:229-444-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL167562207Q00000X
GA99075207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine