Provider Demographics
NPI:1245584168
Name:SHOOK, SUSAN L (RN)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:SHOOK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2699
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1384
Mailing Address - Country:US
Mailing Address - Phone:678-391-5950
Mailing Address - Fax:678-391-5969
Practice Address - Street 1:5345 CROSSROADS DRIVE
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2536
Practice Address - Country:US
Practice Address - Phone:678-391-5950
Practice Address - Fax:678-391-5969
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224860163WA0400X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator