Provider Demographics
NPI:1952396798
Name:HARDING, SUSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:HARDING
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-0148
Mailing Address - Country:US
Mailing Address - Phone:229-263-8956
Mailing Address - Fax:229-263-4671
Practice Address - Street 1:905 N COURT ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1362
Practice Address - Country:US
Practice Address - Phone:229-263-8956
Practice Address - Fax:229-263-4671
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000376087AMedicaid
GA31013OtherSTATE OF GA
498108OtherBCBS
C34429Medicare UPIN
498108OtherBCBS
2277D6D24AMedicare ID - Type Unspecified