Provider Demographics
NPI:1083729610
Name:ROSS, SUSAN HORION (FNP, PNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:HORION
Last Name:ROSS
Suffix:
Gender:F
Credentials:FNP, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 BLENHEIM CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4571
Mailing Address - Country:US
Mailing Address - Phone:770-928-6242
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:BUILDING C SUITE 545
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-751-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN701446363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner