Healthcare Provider Details

I. General information

NPI: 1205834231
Provider Name (Legal Business Name): SUZANNE MICHELLE WESTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE MICHELLE SCHODTLER

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 TRADITIONS WAY
JEFFERSON GA
30549-7992
US

IV. Provider business mailing address

1340 TRADITIONS WAY
JEFFERSON GA
30549-7992
US

V. Phone/Fax

Practice location:
  • Phone: 706-654-3704
  • Fax:
Mailing address:
  • Phone: 706-654-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP29561722
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN183826
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: