Provider Demographics
NPI:1760912596
Name:ALFORD, SUSAN ASHLEY (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ASHLEY
Last Name:ALFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ASHLEY
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 WIMBLEDON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8221
Mailing Address - Country:US
Mailing Address - Phone:478-550-0274
Mailing Address - Fax:
Practice Address - Street 1:6005 WATSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6542
Practice Address - Country:US
Practice Address - Phone:478-956-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily