Provider Demographics
NPI:1558907014
Name:TOBIAS, SUSIE HALL
Entity Type:Individual
Prefix:
First Name:SUSIE
Middle Name:HALL
Last Name:TOBIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BANKS WEIR RD
Mailing Address - Street 2:
Mailing Address - City:BLACKSTOCK
Mailing Address - State:SC
Mailing Address - Zip Code:29014-9431
Mailing Address - Country:US
Mailing Address - Phone:803-209-0282
Mailing Address - Fax:
Practice Address - Street 1:80 BANKS WEIR RD
Practice Address - Street 2:
Practice Address - City:BLACKSTOCK
Practice Address - State:SC
Practice Address - Zip Code:29014-9431
Practice Address - Country:US
Practice Address - Phone:803-209-0282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider