Provider Demographics
NPI:1467532325
Name:GREY, SUSAN WALKER (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WALKER
Last Name:GREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TREE LANE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:770-979-0367
Mailing Address - Fax:770-979-1830
Practice Address - Street 1:1800 TREE LANE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:770-979-0367
Practice Address - Fax:770-979-0367
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041571207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACO7170OtherRAILROAD MEDICARE
GA00711015AMedicaid
GAGRP2664OtherGROUP MEDICARE
GA00711015AMedicaid
GAGRP2664OtherGROUP MEDICARE