Provider Demographics
NPI:1558391326
Name:TAYLOR, SUSAN GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:GARY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:TAYLOR
Other - Last Name:PEPPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:2205 MCCALLIE AVE FL 4
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-2435
Practice Address - Fax:423-697-8370
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19448207RC0200X, 207RP1001X
SC19661207RC0200X, 208M00000X
IN01053483207RP1001X
TN25648207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL073104562OtherBCBS OF AL
MS03157396Medicaid
P00371168Medicare PIN
MS03157396Medicaid
MS290000161Medicare PIN