SUSAN GAIL STAVISS (NPI# 1346242229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346242229 |
| Entity Type | Individual |
| Full Name | SUSAN GAIL STAVISS |
| Credential | M.D. |
| Practice Address |
3939 Roswell Rd Suite 300 Marietta GA 30062-6251 |
| Practice Telephone | 7705782868 |
| Practice Fax Number | 7709718499 |
| Mailing Telephone | 7705782868 |
| Mailing Fax Number | 7709718499 |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2019-10-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
038652 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | CIGNA | 3308662027 | 01 |
| GA | 000607703D | 05 | |
| GA | PRIVATE HEALTHCARE SYSTEM | 241020 | 01 |
| GA | AETNA USHEALTHCARE | 4508167 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 205 Hawkins Store Rd Nw Ste B1, Kennesaw, GA 301446215 | 7709280862 |
| Street Address |
3939 ROSWELL RD SUITE 300 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-6251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578049656 | Christine Ghilain | Clinical Neuropsychologist | 3939 Roswell Rd, Marietta, GA 30062-6251 | 2018-07-12 |
| 1841722212 | Southeast Integrative Medicine | Naturopath | 3939 Roswell Rd, Suite 240, Marietta, GA 30062-6251 | 2017-04-03 |
| 1780924043 | Wellstar Medical Group, LLC | Pediatrics | 3939 Roswell Rd, Suite 300, Marietta, GA 30062-6251 | 2013-02-25 |
| 1275814964 | Wellstar Medical Group, LLC | Family Medicine | 3939 Roswell Rd, Suite 240, Marietta, GA 30062-6251 | 2011-09-08 |
| 1124251590 | Tanya Theriot, Psy.d., P.C. | Psychologist | 3939 Roswell Rd, Suite 185, Marietta, GA 30062-6251 | 2009-09-01 |
| 1952464505 | Marietta Eye Optical Inc | Durable Medical Equipment & Medical Supplies | 3939 Roswell Rd, Suite 100, Marietta, GA 30062-6251 | 2006-12-18 |
| 1689736860 | Marietta Eye Clinic, Pa | Optometrist | 3939 Roswell Rd, Suite 100, Marietta, GA 30062 | 2006-12-14 |
| 1992866818 | Robin Lisa King | Social Worker | 3939 Roswell Rd, Suite 185, Marietta, GA 30062-6251 | 2006-12-13 |
| 1851468078 | Parkway Therapy Services, Inc. Dba East Cobb Physical Therapy | Physical Therapist | 3939 Roswell Rd, Suite 160, Marietta, GA 30062-6251 | 2006-11-30 |
| 1700958394 | Sona P Amin | Internal Medicine | 3939 Roswell Rd, Suite 110, Marietta, GA 30062-6251 | 2006-11-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578051 | Pamela D Kretzmer | Social Worker | 3855 Shallowford Road, Suite 420, Marietta, GA 30062 | 2020-11-03 |
| 1932714680 | Michelle Chambless | Physical Therapist | Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 | 2020-09-10 |
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1104451160 | Sno Healthcare Group | Clinic/Center | 2424 Roswell Rd Ste 120, Marietta, GA 30062 | 2020-03-10 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1073159034 | Magdala Tulcie Jodesty-jackson | Social Worker | 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 | 2019-11-25 |
| 1598235178 | Matthew Driggers | Counselor | 4343 Shallowford Rd C2, Marietta, GA 30062 | 2018-11-27 |
| 1750895785 | Emily Grace Minday | Counselor | 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 | 2017-11-29 |
| 1477072122 | Jason Lee Amos | Speech-Language Pathologist | 3660 Chestnut Ridge Court, Marietta, GA 30062 | 2017-09-13 |
| 1346761376 | Marian Pomaah Opoku-agyeman | Nurse Practitioner | 4661 Andrea Pointe, Marietta, GA 30062 | 2017-06-29 |
| Find all providers in zip 30062 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679523443 | Craig L Lebish | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2006-05-11 |
| 1386078152 | Cobb Pediatrics | Pediatrics | 3405 Dallas Hwy Sw, Suite 300, Marietta, GA 30064-6425 | 2013-08-28 |
| 1154687721 | Tina Kim Vothang | Pediatrics | 3747 Roswell Rd, Suite 201, Marietta, GA 30062-6215 | 2012-04-08 |
| 1265759229 | Anna Chandler Schulenborg | Pediatrics | 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 | 2010-04-29 |
| 1922268838 | Pediatric and Adolescent Healthcare,pc | Pediatrics | 1163 Johnson Ferry Rd, Suite 170, Marietta, GA 30068-2764 | 2008-06-13 |
| 1407045495 | Kaleidoscope Pediatrics PC | Pediatrics | 1523 Johnson Ferry Rd, Suite 150, Marietta, GA 30062-6438 | 2007-10-16 |
| 1841337896 | East Cobb Pediatrics and Adolescent Medicine, PC | Pediatrics | 1121 Johnson Ferry Rd, Suite 220, Marietta, GA 30068-5425 | 2007-01-31 |
| 1962550467 | Dara Hosch | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2007-01-08 |
| 1558428193 | Tamara Nix | Pediatrics | 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 | 2007-01-02 |
| 1538240353 | Erika Sandra Van Putten | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2006-10-18 |
| Find all providers in MARIETTA | ||||
Please comment or provide details below to improve the information on SUSAN GAIL STAVISS.
| 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.