Provider Demographics
NPI:1467623363
Name:SEXTON, SUSAN CAPITAN (NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CAPITAN
Last Name:SEXTON
Suffix:
Gender:F
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 APPLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2955
Mailing Address - Country:US
Mailing Address - Phone:770-579-5868
Mailing Address - Fax:
Practice Address - Street 1:574 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1358
Practice Address - Country:US
Practice Address - Phone:770-519-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist