Provider Demographics
NPI:1235464066
Name:SPRANKLIN, SUSANNE GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:GRACE
Last Name:SPRANKLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 MEDICAL CENTER PARKWAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-907-2040
Mailing Address - Fax:615-907-2827
Practice Address - Street 1:1800 MEDICAL CENTER PKWY STE 350
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2586
Practice Address - Country:US
Practice Address - Phone:615-907-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03633207V00000X
TN3024207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100261460Medicaid
K096820Medicare PIN