Provider Demographics
NPI:1497787949
Name:ORCUTT, SUSAN BROWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BROWN
Last Name:ORCUTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2670 EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-5232
Mailing Address - Country:US
Mailing Address - Phone:404-323-5661
Mailing Address - Fax:
Practice Address - Street 1:403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3503
Practice Address - Country:US
Practice Address - Phone:706-646-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004483363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00927564OtherRR MEDICARE
GA376314055AMedicaid
97WCGMLMedicare PIN
GA376314055AMedicaid
GAP00927564OtherRR MEDICARE