Provider Demographics
NPI:1639225220
Name:BOZZONE, SUZANNAH LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNAH
Middle Name:LEIGH
Last Name:BOZZONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5545 LITTLE DEBBIE PKWY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4357
Mailing Address - Country:US
Mailing Address - Phone:707-938-3870
Mailing Address - Fax:707-938-3895
Practice Address - Street 1:5545 LITTLE DEBBIE PKWY
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4357
Practice Address - Country:US
Practice Address - Phone:423-455-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47914207Q00000X
TN54329207Q00000X
CAA106783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine