Provider Demographics
NPI:1457305161
Name:FINCH, SUSAN GAIL (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GAIL
Last Name:FINCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:GAIL
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1060 PEERLESS XING NW STE 200
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3785
Mailing Address - Country:US
Mailing Address - Phone:423-479-4165
Mailing Address - Fax:423-476-9360
Practice Address - Street 1:1060 PEERLESS XING NW STE 200
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3785
Practice Address - Country:US
Practice Address - Phone:423-479-4165
Practice Address - Fax:423-476-9360
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29990207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1529356Medicaid
SC220095Medicaid
H27456Medicare ID - Type Unspecified