Healthcare Provider Details

I. General information

NPI: 1871506279
Provider Name (Legal Business Name): SUSAN JEAN DREYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EXECUTIVE PARK SOUTH NE SUITE 3000
ATLANTA GA
30329-2208
US

IV. Provider business mailing address

59 EXECUTIVE PARK SOUTH NE SUITE 3000
ATLANTA GA
30329-2208
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6359
  • Fax: 404-778-7117
Mailing address:
  • Phone: 404-778-6359
  • Fax: 404-778-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number035617
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number035617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: