Healthcare Provider Details

I. General information

NPI: 1225012156
Provider Name (Legal Business Name): SUZANNE M CLOUS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLUMBIA DR APT 3306
CAPE CANAVERAL FL
32920-5106
US

IV. Provider business mailing address

300 COLUMBIA DR APT 3306
CAPE CANAVERAL FL
32920-5106
US

V. Phone/Fax

Practice location:
  • Phone: 404-556-1710
  • Fax:
Mailing address:
  • Phone: 404-556-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD001011
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4609
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD001011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: