MEDICARE: SUSAN THI LE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-05576	NC
2	363A00000X	Physician Assistant	7529	GA
3	363A00000X	Physician Assistant	PA10283	TX

General Provider Information

NPI Number	:	1104210863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN THI LE PA-C

Provider Business Mailing Address
First Line	:	2410 N OAK ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2533
Country	:	US
Telephone Number	:	229-241-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 N OAK ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2533
Country	:	US
Telephone Number	:	229-241-7546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2015
Last Update Date	:	01/05/2026

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Directions to “ SUSAN THI LE PA-C” Practice Location

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