Provider Demographics
NPI:1932145612
Name:WILLIAMS, SUSAN (DC)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 S CHEROKEE LN
Mailing Address - Street 2:STE 1810
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4797
Mailing Address - Country:US
Mailing Address - Phone:404-259-2992
Mailing Address - Fax:
Practice Address - Street 1:3221 S CHEROKEE LN
Practice Address - Street 2:STE 1810
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4797
Practice Address - Country:US
Practice Address - Phone:404-259-2992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7026OtherMEDICARE GROUP NUMBER
GA000898136AMedicaid
GA35ZCGCCMedicare ID - Type Unspecified
GA000898136AMedicaid