Provider Demographics
NPI:1184759243
Name:HERRIN, SUZANNE L (PA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:HERRIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:ELISE
Other - Last Name:LIVINGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:2000 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-801-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004979363AM0700X
ALPA 719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051111212OtherBLUE CROSS & BLUE SHIELD
AL051111213OtherBLUE CROSS & BLUE SHIELD
GA261470131AMedicaid
MS08488856OtherMEDICAID OF MISSISSIPPI
MS08488856Medicaid
AL124578Medicaid
AL051111214OtherBLUE CROSS & BLUE SHIELD
GAQ76771Medicare UPIN
GA261470131AMedicaid
102I978830Medicare PIN
AL051111214OtherBLUE CROSS & BLUE SHIELD