Provider Demographics
NPI:1083050215
Name:CHILDERS, SUZANNE A (NP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:A
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S CHESTATEE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-5503
Mailing Address - Country:US
Mailing Address - Phone:706-867-6005
Mailing Address - Fax:706-867-6012
Practice Address - Street 1:1300 S CHESTATEE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-5503
Practice Address - Country:US
Practice Address - Phone:706-867-6005
Practice Address - Fax:706-867-6012
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN17911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily