Healthcare Provider Details

I. General information

NPI: 1215935903
Provider Name (Legal Business Name): SUSAN H LAND M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 MOUNT PLEASANT RD
THOMSON GA
30824-8140
US

IV. Provider business mailing address

PO BOX 2510
EVANS GA
30809-2510
US

V. Phone/Fax

Practice location:
  • Phone: 706-595-1461
  • Fax: 706-597-9824
Mailing address:
  • Phone: 706-922-8251
  • Fax: 706-922-6695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46878
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: