| Suman Annambhotla, MD | |
|
725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 | |
| (678) 207-4000 | |
| (770) 531-2435 |
| Full Name | Suman Annambhotla |
|---|---|
| Gender | Male |
| Speciality | Vascular Surgery |
| Experience | 20 Years |
| Location | 725 Jesse Jewell Pkwy Se, Gainesville, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760712889 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208600000X | Surgery | M8500 (Texas) | Secondary |
| 2086S0129X | Surgery - Vascular Surgery | 070035 (Georgia) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Northside Hospital Gwinnett | Lawrenceville, GA | Hospital |
| Northside Hospital Forsyth | Cumming, GA | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Northside Surgical Professional Services Llc | 8628253424 | 332 |
| Entity Name | Northside Surgical Professional Services Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356630990 PECOS PAC ID: 8628253424 Enrollment ID: O20110420000598 |
| Mailing Address | Practice Location Address |
|---|---|
| Suman Annambhotla, MD Po Box 658, Gainesville, GA 30503-0658 Ph: (770) 718-1122 | Suman Annambhotla, MD 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 Ph: (678) 207-4000 |
Dr. Thomas Gregory Delong, M.D. Surgery Medicare: Not Enrolled in Medicare Practice Location: 1387 Springdale Rd, Gainesville, GA 30501 Phone: 770-534-0984 | |
Courtney L Grant, M.D. Surgery Medicare: Accepting Medicare Assignments Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 678-207-4000 Fax: 770-531-2435 | |
Mary Hannah Read, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-533-6523 | |
Phillip Patrick Rideout, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 200 S Enota Dr Ne Ste 360, Gainesville, GA 30501 Phone: 770-219-4000 | |
Derek Paul Pendarvis, MD Surgery Medicare: Accepting Medicare Assignments Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-536-2323 Fax: 770-536-4947 | |
Julius Timothy Fulenwider, MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 1075 Jesse Jewell Pkwy Ne, Ste B, Gainesville, GA 30501 Phone: 770-536-5733 Fax: 770-534-2114 | |
James A. Butts Jr., MD Surgery Medicare: Not Enrolled in Medicare Practice Location: 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501 Phone: 770-536-2323 Fax: 770-536-4947 |