Provider Demographics
NPI:1750694956
Name:SUSONG, REBECCA GUESS (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GUESS
Last Name:SUSONG
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 TAFT HWY STE 6
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-3527
Mailing Address - Country:US
Mailing Address - Phone:423-451-6683
Mailing Address - Fax:423-214-1027
Practice Address - Street 1:1807 TAFT HWY STE 6
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-3527
Practice Address - Country:US
Practice Address - Phone:423-451-6683
Practice Address - Fax:423-214-1027
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD60592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics