Provider Demographics
NPI:1376977991
Name:DEVINE, SUZANNE POOL (ACNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:POOL
Last Name:DEVINE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 GREEN HILL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2043
Mailing Address - Country:US
Mailing Address - Phone:404-227-4996
Mailing Address - Fax:
Practice Address - Street 1:305 GREEN HILL RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2043
Practice Address - Country:US
Practice Address - Phone:404-227-4996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAUNKNOWN AT PRESENT363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care