Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MT004367 | GA |
NPI | 1144498882 |
---|---|
Provider Name | Suzanne C Easley |
First Address | Cumming, GA 30040-5133 |
Second Address | Cumming, GA 30040-2492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2008 |
Last Update Date | 15/02/2008 |