Provider Demographics
NPI:1346234903
Name:SUSIN, BARBARA LEE ANNE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:LEE ANNE
Last Name:SUSIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4181 HOSPITAL DR NE STE 104
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:770-385-8954
Mailing Address - Fax:770-385-8590
Practice Address - Street 1:4181 HOSPITAL DR NE STE 104
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:770-385-8954
Practice Address - Fax:770-385-8590
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9226657367A00000X
GARN116490367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003104261BMedicaid
GA201I420180Medicare UPIN