Provider Demographics
NPI:1669589131
Name:FALCONE, SUSAN M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:M
Last Name:FALCONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:MEDROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2538
Mailing Address - Country:US
Mailing Address - Phone:404-355-4393
Mailing Address - Fax:404-419-9852
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-355-4393
Practice Address - Fax:404-419-9852
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1862-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM1268499OtherDEA NUMBER
018200019Medicare ID - Type UnspecifiedMEDICARE PROVIDER
MM1268499OtherDEA NUMBER