Provider Demographics
NPI:1144466699
Name:RAGAINS, SUSAN S (RN,FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:S
Last Name:RAGAINS
Suffix:
Gender:F
Credentials:RN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-2152
Mailing Address - Country:US
Mailing Address - Phone:912-564-2821
Mailing Address - Fax:
Practice Address - Street 1:114 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:GA
Practice Address - Zip Code:30830-5446
Practice Address - Country:US
Practice Address - Phone:706-554-3618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048215163W00000X
GA0035673363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse