Provider Demographics
NPI:1326793720
Name:SMITH, SUSAN BIRD (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BIRD
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:BIRD
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:400 TOWER RD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9412
Mailing Address - Country:US
Mailing Address - Phone:470-956-8260
Mailing Address - Fax:
Practice Address - Street 1:8954 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2272
Practice Address - Country:US
Practice Address - Phone:470-956-8260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284480363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care