Provider Demographics
NPI:1972595312
Name:BROWN, SUSAN PATRICE (ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PATRICE
Last Name:BROWN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:PATRICE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31546-2805
Mailing Address - Country:US
Mailing Address - Phone:912-427-2209
Mailing Address - Fax:
Practice Address - Street 1:303 FRASER DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3712
Practice Address - Country:US
Practice Address - Phone:912-877-2227
Practice Address - Fax:912-877-2332
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN053925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390415OtherBLUE CROSS BLUE SHIELD
GA50BBHZMMedicare ID - Type UnspecifiedPROVIDER NUMBER
GAP00212483Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
GAP47474Medicare UPIN