Provider Demographics
NPI:1568476778
Name:HAGOOD, SUSAN H (RD,LD,CDE)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:H
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:RD,LD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 FORREST BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4736
Mailing Address - Country:US
Mailing Address - Phone:404-289-0054
Mailing Address - Fax:404-286-2797
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:#120
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-286-9727
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD000378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered