Healthcare Provider Details

I. General information

NPI: 1649583329
Provider Name (Legal Business Name): SUSAN VARGHESE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD STE 520
ATLANTA GA
30342-5005
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD STE 520
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-5801
  • Fax: 678-843-7746
Mailing address:
  • Phone: 678-843-5801
  • Fax: 678-843-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN169364
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 169364
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN169364
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: