Provider Demographics
NPI:1821093816
Name:TAYLOR, SUSAN JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOHNSON
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HORIZON MEDICAL, PC
Mailing Address - Street 2:1445 SHELDON, SUITE 301
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-847-2500
Mailing Address - Fax:616-847-6719
Practice Address - Street 1:HORIZON MEDICAL, PC
Practice Address - Street 2:1445 SHELDON, SUITE 301
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417
Practice Address - Country:US
Practice Address - Phone:616-847-2500
Practice Address - Fax:616-847-6719
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048050207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4685205Medicaid
MA4685205Medicaid