Healthcare Provider Details

I. General information

NPI: 1073842928
Provider Name (Legal Business Name): SUSAN RACHEL LAYTON EDD, RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 OLYMPIC WAY
ACWORTH GA
30102
US

IV. Provider business mailing address

519 OLYMPIC WAY
ACWORTH GA
30102
US

V. Phone/Fax

Practice location:
  • Phone: 912-441-0490
  • Fax:
Mailing address:
  • Phone: 912-441-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRW57504
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: