Provider Demographics
NPI:1649269929
Name:MCCHESNEY-ATKINS, SUSAN R (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:R
Last Name:MCCHESNEY-ATKINS
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 1:6325 HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2300
Mailing Address - Country:US
Mailing Address - Phone:901-522-7700
Mailing Address - Fax:901-522-2550
Practice Address - Street 1:6325 HUMPHREYS BLVD
Practice Address - Street 2:SEMMES MURPHEY CLINIC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2300
Practice Address - Country:US
Practice Address - Phone:901-522-7700
Practice Address - Fax:901-259-2020
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP01996103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3687567Medicaid
TN3687567Medicare PIN
S00874Medicare UPIN