Provider Demographics
NPI:1144488545
Name:RICHARDSON, SUSAN A (CFNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 BRECKINRIDGE BLVD STE 415
Mailing Address - Street 2:AID GWINNETT
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4981
Mailing Address - Country:US
Mailing Address - Phone:770-962-8396
Mailing Address - Fax:
Practice Address - Street 1:3075 BRECKINRIDGE BLVD STE 415
Practice Address - Street 2:AID GWINNETT
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4981
Practice Address - Country:US
Practice Address - Phone:770-962-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN073504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000979921BMedicaid