Provider Demographics
NPI:1578819942
Name:DUPREE, SUSAN LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:DUPREE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:LEE
Other - Last Name:CHRISTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1825 MARTHA BERRY BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1625
Mailing Address - Country:US
Mailing Address - Phone:706-295-5331
Mailing Address - Fax:
Practice Address - Street 1:1825 MARTHA BERRY BLVD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1625
Practice Address - Country:US
Practice Address - Phone:706-238-8073
Practice Address - Fax:706-238-8081
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193186363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126977AMedicaid
GA003126977AMedicaid