FAIROZ MATJAN RADTKE (NPI# 1114207032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114207032 |
| Entity Type | Individual |
| Full Name | FAIROZ MATJAN RADTKE |
| Credential | PA-C |
| Practice Address |
5400 Laurel Springs Pkwy Suite 1401 Suwanee GA 30024-6056 |
| Mailing Address |
5850 Eubank Blvd Ne Ste B32 Albuquerque NM 87111-6127 |
| Practice Telephone | 6785132228 |
| Practice Fax Number | 6785131147 |
| Mailing Telephone | 6785132228 |
| Mailing Fax Number | 6785131147 |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2018-06-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
003766 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5400 LAUREL SPRINGS PKWY SUITE 1401 |
| City | SUWANEE |
| State | GA |
| Zip Code | 30024-6056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659313195 | Atlanta Psychiatric Institute | Psychiatry & Neurology | 5400 Laurel Springs Pkwy, Unit 602, Suwanee, GA 30024-6056 | 2006-06-11 |
| 1841833134 | Chelsea Moodie | Counselor | 5400 Laurel Springs Pkwy, Suwanee, GA 30024-6056 | 2019-10-20 |
| 1265088108 | Mariah Dookie | Counselor | 5400 Laurel Springs Pkwy, Suwanee, GA 30024-6056 | 2019-08-15 |
| 1952828386 | Sarah Anne Eilert | Speech-Language Pathologist | 5400 Laurel Springs Pkwy, Suwanee, GA 30024-6056 | 2017-08-25 |
| 1790202349 | Helen M Gunasekharan | Occupational Therapist | 5400 Laurel Springs Pkwy, Suwanee, GA 30024-6056 | 2017-08-24 |
| 1659822435 | Hudes Concierge Medicine, LLC | Internal Medicine | 5400 Laurel Springs Pkwy, Bldg 1400, Suite A, Suwanee, GA 30024-6056 | 2016-10-17 |
| 1801255161 | Lisa Black | Speech-Language Pathologist | 5400 Laurel Springs Pkwy, Bldg 400 #404, Suwanee, GA 30024-6056 | 2016-02-15 |
| 1346605920 | Traxler Primary Care, LLC | Pediatrics | 5400 Laurel Springs Pkwy, Suite 1402, Suwanee, GA 30024-6056 | 2015-12-23 |
| 1417323387 | Medprime North, Inc. | Pediatrics | 5400 Laurel Springs Pkwy, Suite 1402, Suwanee, GA 30024-6056 | 2015-08-14 |
| 1477935195 | Sharita Stewart | Speech-Language Pathologist | 5400 Laurel Springs Pkwy, Suwanee, GA 30024-6056 | 2015-06-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996565 | Stephanie Arkin | Student in an Organized Health Care Education/Training Program | 25 Old Peachtree Rd Nw, Suwanee, GA 30024 | 2019-08-05 |
| 1164989638 | Laquitta Craft | Registered Nurse | 2855 Lawrenceville Suwanee Road Suite 330/340, Suwanee, GA 30024 | 2019-02-21 |
| 1467937235 | Greater Atlanta Monitoring, LLC | Electrodiagnostic Medicine | 3651 Peachtree Ste E. #331, Suwanee, GA 30024 | 2018-09-27 |
| 1760963482 | Esther Natacha Lafontant | Public Health or Welfare | 3205 Maple Terrace Drive, Suwanee, GA 30024 | 2018-08-22 |
| 1740778463 | Immaculate Healthcare Solutions, LLC | Home Health | 970 Peachtree Industrial Blvd Ste 8, Suwanee, GA 30024 | 2018-04-27 |
| 1053819235 | Sean Wonsuk Jang | Chiropractor | 3370 Lawrenceville Suwanee Rd Ste 118, Suwanee, GA 30024 | 2018-01-23 |
| 1932628468 | Silver Health Services, Inc. | Case Manager/Care Coordinator | 2640 Westbury Court, Swanee, GA 30024 | 2017-09-15 |
| 1285159095 | April L. Rivers | Nurse Practitioner | 4411 Suwanee Dam Rd Ste 110, Suwanee, GA 30024 | 2017-08-14 |
| 1144743840 | Nabil Elkareh | Pharmacist | 5049 Tarry Glen Drive., Suwanee, GA 30024 | 2017-07-25 |
| 1720508294 | Robert A Finkel Dds PC | Clinic/Center | 1325 Satellite Blvd Nw Ste 1304, Suwanee, GA 30024 | 2017-06-26 |
| Find all providers in zip 30024 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679855001 | Shima Mansouri | Physician Assistant | 3890 Johns Creek Pkwy Ste 360, Suwanee, GA 30024-1286 | 2011-09-12 |
| 1124088851 | Leah R Reynolds | Physician Assistant | 4245 Johns Creek Pkwy, Ste D, Suwanee, GA 30024-9121 | 2006-03-25 |
| 1275527061 | Lisa Christine Diglio | Physician Assistant | 3925 A John's Creek Court, Suwanee, GA 30024 | 2005-09-07 |
| 1568901445 | Olivia Mary Flory | Physician Assistant | 1300 Peachtree Industrial Blvd, Suwanee, GA 30024-4539 | 2017-02-13 |
| 1598204463 | Mandy Ulseth | Physician Assistant | 1300 Peachtree Industrial Blvd, Suite 4101, Suwanee, GA 30024-4539 | 2017-02-13 |
| 1093121964 | Julia S Lee | Physician Assistant | 4285 Johns Creek Pkwy, Suite A, Suwanee, GA 30024-6038 | 2014-07-10 |
| 1730593815 | John Caleb Henson | Physician Assistant | 1300 Peachtree Industrial Blvd, Suite 4101, Suwanee, GA 30024-4539 | 2014-06-17 |
| 1710125745 | Haleh M Stratton | Physician Assistant | 4045 Johns Creek Pkwy, Suite C, Suwanee, GA 30024-1253 | 2009-01-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.