Healthcare Provider Details

I. General information

NPI: 1891770699
Provider Name (Legal Business Name): MARY SUSANN BEDFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY SUSANN WAMSLEY

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD NE SUITE 870
ATLANTA GA
30342-1731
US

IV. Provider business mailing address

PO BOX 631856
BALTIMORE MD
21263-1856
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-2975
  • Fax: 404-255-2276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number35480
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: