Provider Demographics
NPI:1619016227
Name:MATTHEWS, SUSANNE SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:SMITH
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 CARISBROOKE CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-1400
Mailing Address - Country:US
Mailing Address - Phone:205-978-9364
Mailing Address - Fax:
Practice Address - Street 1:1001 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5701
Practice Address - Country:US
Practice Address - Phone:256-237-1618
Practice Address - Fax:256-237-2661
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.15160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE-87624OtherVIVA HEALTH
AL529101580Medicaid
AL10285OtherHEALTHSPRINGS OF AL
AL4006023OtherAETNA
510-89387OtherBCBS
ALE-87624OtherVIVA HEALTH