Provider Demographics
NPI:1639112584
Name:BLANK, SUSAN KAYE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KAYE
Last Name:BLANK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1846 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8801
Mailing Address - Country:US
Mailing Address - Phone:770-696-9862
Mailing Address - Fax:770-710-0243
Practice Address - Street 1:1846 OLD NORCROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8801
Practice Address - Country:US
Practice Address - Phone:770-696-9862
Practice Address - Fax:770-710-0243
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-09-10
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Provider Licenses
StateLicense IDTaxonomies
GA0337822084P2900X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine