Provider Demographics
NPI:1639498934
Name:EMMETT, SUSAN DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DAVIS
Last Name:EMMETT
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:BOX 3805 MED CTR
Mailing Address - Street 2:DUMC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:919-684-6968
Mailing Address - Fax:
Practice Address - Street 1:501 JACK STEPHENS DR # 547-05
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5551
Practice Address - Country:US
Practice Address - Phone:501-686-5878
Practice Address - Fax:501-686-8644
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK116601207Y00000X
MDD0082644207Y00000X
NC2017-00540207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology