Provider Demographics
NPI:1134266539
Name:MEEKS, SUSAN REINE (CPM - TN)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:REINE
Last Name:MEEKS
Suffix:
Gender:F
Credentials:CPM - TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5566 BIG EAST FORK RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-9482
Mailing Address - Country:US
Mailing Address - Phone:615-794-0872
Mailing Address - Fax:615-591-5473
Practice Address - Street 1:5566 BIG EAST FORK RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-9482
Practice Address - Country:US
Practice Address - Phone:615-794-0872
Practice Address - Fax:615-591-5473
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCPM0000000013176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3149014OtherBLUE CROSS BLUE SHIELD