Healthcare Provider Details

I. General information

NPI: 1265838999
Provider Name (Legal Business Name): IMAGES BY SUSAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FAIR HOPE LN
BLUFFTON SC
29910-5733
US

IV. Provider business mailing address

4 FAIR HOPE LN
BLUFFTON SC
29910-5733
US

V. Phone/Fax

Practice location:
  • Phone: 404-401-1441
  • Fax:
Mailing address:
  • Phone: 404-401-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateSC

VIII. Authorized Official

Name: SUSAN CHURCH
Title or Position: ULTRASOUND TECHNICIAN
Credential: RCS
Phone: 404-401-1441