Healthcare Provider Details

I. General information

NPI: 1407773021
Provider Name (Legal Business Name): SUSAN LEE ENGLISH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

IV. Provider business mailing address

11740 COLUMBIA ST
BLAKELY GA
39823-2574
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-4241
  • Fax: 229-723-2930
Mailing address:
  • Phone: 229-723-4241
  • Fax: 229-723-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License NumberI34447
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN199730
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: