Provider Demographics
NPI:1396994521
Name:OVERTON, SUSAN ANGERHOLZER (PA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANGERHOLZER
Last Name:OVERTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2301
Mailing Address - Country:US
Mailing Address - Phone:251-471-3544
Mailing Address - Fax:251-471-3544
Practice Address - Street 1:1901 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2303
Practice Address - Country:US
Practice Address - Phone:251-300-2240
Practice Address - Fax:251-300-2249
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.613363AS0400X
ALTA 1674363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5101970136Medicare PIN