Provider Demographics
NPI:1558474783
Name:WATSON, SUSAN COHAN (CFNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:COHAN
Last Name:WATSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:COHAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 HIGHWAY 34 E STE 3000
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6430
Practice Address - Country:US
Practice Address - Phone:770-252-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR837449363LF0000X
GARN069109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0125679Medicaid
MS0125679Medicaid