Healthcare Provider Details

I. General information

NPI: 1891770327
Provider Name (Legal Business Name): SUSAN HOLLANDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW SUITE 115
MARIETTA GA
30060-1134
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1620
ATLANTA GA
30308-2209
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-3075
  • Fax: 770-427-3261
Mailing address:
  • Phone: 404-885-7701
  • Fax: 404-885-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2504
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: