Provider Demographics
NPI:1942316377
Name:ANDREWS, SUSAN DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DEBORAH
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 HIGHWAY 51
Mailing Address - Street 2:SUITE F2
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3424
Mailing Address - Country:US
Mailing Address - Phone:601-856-2290
Mailing Address - Fax:601-856-3290
Practice Address - Street 1:299 HIGHWAY 51
Practice Address - Street 2:SUITE F2
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3424
Practice Address - Country:US
Practice Address - Phone:601-856-2290
Practice Address - Fax:601-856-3290
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS14224OtherLICENSE
A78818Medicare UPIN