Provider Demographics
NPI:1356334569
Name:DUCKETT, SUZANNA G (MD)
Entity type:Individual
Prefix:DR
First Name:SUZANNA
Middle Name:G
Last Name:DUCKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUZANNA
Other - Middle Name:G
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:274 BIG A ROAD
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6002
Mailing Address - Country:US
Mailing Address - Phone:706-282-5363
Mailing Address - Fax:706-282-4091
Practice Address - Street 1:274 BIG A ROAD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6002
Practice Address - Country:US
Practice Address - Phone:706-282-5363
Practice Address - Fax:706-282-4091
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA468372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000669655AMedicaid
GA000669655AMedicaid