Provider Demographics
NPI:1225012156
Name:CLOUS, SUZANNE M (DPM)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:CLOUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4329 DOVER CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2167
Mailing Address - Country:US
Mailing Address - Phone:404-556-1710
Mailing Address - Fax:
Practice Address - Street 1:4329 DOVER CROSSING DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2167
Practice Address - Country:US
Practice Address - Phone:404-556-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001011213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I480075Medicare PIN
V04861Medicare UPIN