Provider Demographics
NPI:1811186216
Name:SUZANNE L. NUNN, MD PC
Entity Type:Organization
Organization Name:SUZANNE L. NUNN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEE DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:706-745-2229
Mailing Address - Street 1:63 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2291
Mailing Address - Country:US
Mailing Address - Phone:706-745-2229
Mailing Address - Fax:706-745-0836
Practice Address - Street 1:63 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2291
Practice Address - Country:US
Practice Address - Phone:706-745-2229
Practice Address - Fax:706-745-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89066J4Medicaid
GAP00153442OtherRR MEDICARE
GA643758213AMedicaid
GA187001OtherBC/BS
GA187001OtherBC/BS
GAP00153442OtherRR MEDICARE