Provider Demographics
NPI:1477230720
Name:ADAMS, SUSAN G (MED)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1164 MILMAR DR N.W.
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1620
Mailing Address - Country:US
Mailing Address - Phone:404-698-3699
Mailing Address - Fax:
Practice Address - Street 1:1164 MILMAR DR N.W.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1620
Practice Address - Country:US
Practice Address - Phone:404-698-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001996101YP2500X
GAMAT000135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty