Provider Demographics
NPI:1821202292
Name:THOMSON, SUSAN JANE (NPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JANE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JANE
Other - Last Name:BORICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4372 WINDWARD LN
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3334
Mailing Address - Country:US
Mailing Address - Phone:678-852-7345
Mailing Address - Fax:
Practice Address - Street 1:4372 WINDWARD LN
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3334
Practice Address - Country:US
Practice Address - Phone:678-852-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078351NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health