Provider Demographics
NPI:1912958240
Name:FITZHARRIS, SUSIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:
Last Name:FITZHARRIS
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:P.O. BOX 989
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-0989
Mailing Address - Country:US
Mailing Address - Phone:251-928-0624
Mailing Address - Fax:251-928-0655
Practice Address - Street 1:150 S. INGLESIDE ST
Practice Address - Street 2:SUITE #7
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-928-0624
Practice Address - Fax:251-928-0655
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30746208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000267120Medicaid