Provider Demographics
NPI:1871216721
Name:SUTHAHARAN, LOVEPRIYA (MMSC, PA-C)
Entity type:Individual
Prefix:
First Name:LOVEPRIYA
Middle Name:
Last Name:SUTHAHARAN
Suffix:
Gender:F
Credentials:MMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11305 BELL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-9503
Mailing Address - Country:US
Mailing Address - Phone:470-822-3700
Mailing Address - Fax:
Practice Address - Street 1:11305 BELL RD STE 105
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-9504
Practice Address - Country:US
Practice Address - Phone:470-822-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12360363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty