Provider Demographics
NPI:1376652172
Name:SPITZLER, SUSAN R (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:SPITZLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:RUDNICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 WINDWARD CONCOURSE STE 120
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3971
Mailing Address - Country:US
Mailing Address - Phone:470-731-8010
Mailing Address - Fax:470-731-8005
Practice Address - Street 1:1725 WINDWARD CONCOURSE STE 120
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3971
Practice Address - Country:US
Practice Address - Phone:470-731-8010
Practice Address - Fax:470-731-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045342207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00908575AMedicaid
GA00908575AMedicaid
07BBSJLMedicare ID - Type Unspecified