Provider Demographics
NPI:1982244521
Name:CHEEK, SUSAN JACKSON
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JACKSON
Last Name:CHEEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 AUTUMN CT
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8091
Mailing Address - Country:US
Mailing Address - Phone:770-595-1048
Mailing Address - Fax:
Practice Address - Street 1:6225 AUTUMN CT
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-8091
Practice Address - Country:US
Practice Address - Phone:770-595-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist