Provider Demographics
NPI:1427005354
Name:AUSTIN, SUSAN E (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 21ST AVE S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-4354
Mailing Address - Country:US
Mailing Address - Phone:615-269-0652
Mailing Address - Fax:615-269-0135
Practice Address - Street 1:2464 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4954
Practice Address - Country:US
Practice Address - Phone:678-732-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259939207P00000X, 207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78002763Medicaid
KY78002763Medicaid
KY00368008Medicare PIN
TN103I505304Medicare PIN
TN103I505303Medicare PIN