Healthcare Provider Details

I. General information

NPI: 1629009501
Provider Name (Legal Business Name): SUSAN F MCLENDON APRN, CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 DOCTORS ST
METTER GA
30439-3337
US

IV. Provider business mailing address

PO BOX 407
VIDALIA GA
30475-0407
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-5715
  • Fax:
Mailing address:
  • Phone: 912-537-4986
  • Fax: 912-524-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN060662
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN060662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: