Provider Demographics
NPI:1356348767
Name:EPLEY, SUSAN L (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:EPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9027
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9027
Mailing Address - Country:US
Mailing Address - Phone:706-324-4891
Mailing Address - Fax:706-576-4958
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:BUTLER PAVILION, STE B001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-324-4891
Practice Address - Fax:706-576-4958
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2014-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA475960702FMedicaid
AL154010Medicaid
GA202I169634Medicare PIN
GA475960702CMedicaid
GAD55128Medicare UPIN