Healthcare Provider Details

I. General information

NPI: 1407969173
Provider Name (Legal Business Name): SUSAN I. HEURICH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PARKWAY KAISER PERMANENTE GLENLAKE MEDICAL CENTER
ATLANTA GA
30328
US

IV. Provider business mailing address

3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0966
  • Fax: 770-645-8455
Mailing address:
  • Phone: 404-364-7070
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN070689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: