Healthcare Provider Details

I. General information

NPI: 1639364961
Provider Name (Legal Business Name): SUZANNE W SCHUESSLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 VERNON RD
LAGRANGE GA
30240-4146
US

IV. Provider business mailing address

1527 VERNON RD
LAGRANGE GA
30240-4146
US

V. Phone/Fax

Practice location:
  • Phone: 706-883-6363
  • Fax: 706-884-5588
Mailing address:
  • Phone: 706-883-6363
  • Fax: 706-884-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12822
License Number StateAL

VIII. Authorized Official

Name: DR. SUZANNE WRIGHT SCHUESSLER
Title or Position: MD
Credential: MD
Phone: 706-883-6363