Healthcare Provider Details

I. General information

NPI: 1942597935
Provider Name (Legal Business Name): SUSAN ANN HERRINGTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN ANN RUCKER R.N.

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT GORDON GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-9355
  • Fax: 706-787-0254
Mailing address:
  • Phone: 706-787-9355
  • Fax: 706-787-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN040549
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: