Provider Demographics
NPI:1639364961
Name:SUZANNE W SCHUESSLER
Entity Type:Organization
Organization Name:SUZANNE W SCHUESSLER
Other - Org Name:LAGRANGE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:SCHUESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-883-6363
Mailing Address - Street 1:1527 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4146
Mailing Address - Country:US
Mailing Address - Phone:706-883-6363
Mailing Address - Fax:706-884-5588
Practice Address - Street 1:1527 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4146
Practice Address - Country:US
Practice Address - Phone:706-883-6363
Practice Address - Fax:706-884-5588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUZANNE W. SCHUESSLER, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85002467GMedicaid