Provider Demographics
NPI:1336200229
Name:MAY, SUSAN HUGHES (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HUGHES
Last Name:MAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HABERSHAM DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7353
Mailing Address - Country:US
Mailing Address - Phone:770-461-9944
Mailing Address - Fax:770-461-9779
Practice Address - Street 1:115 HABERSHAM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7353
Practice Address - Country:US
Practice Address - Phone:770-461-9944
Practice Address - Fax:770-461-9779
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10041075OtherAMERIGROUP
GA000627602BMedicaid
GA280924000OtherMIS NUMBER
GA60007635OtherMAGELLAN TIN
GA102890OtherCBH PROVIDER NUMBER
GANPP000Medicare UPIN
GA10041075OtherAMERIGROUP