Provider Demographics
NPI:1407969173
Name:HEURICH, SUSAN I (NP-C)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:I
Last Name:HEURICH
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:20 GLENLAKE PARKWAY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-365-0966
Practice Address - Fax:770-645-8455
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN070689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I500375Medicare UPIN
S7250Medicare UPIN
GA50BBHPMMedicare ID - Type Unspecified
GAS72504Medicare UPIN