Provider Demographics
NPI:1003293432
Name:ZIMMERMAN, SUSAN COLGAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:COLGAN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 HORIZON CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5761
Mailing Address - Country:US
Mailing Address - Phone:678-457-6947
Mailing Address - Fax:
Practice Address - Street 1:815 ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2707
Practice Address - Country:US
Practice Address - Phone:678-947-0952
Practice Address - Fax:678-847-3579
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002562225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant