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General NPI Number Information
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NPI Number | 1164030953
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Entity Type | Individual
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Provider Name | SUSAN BLAIR GAUSE MSN, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2020
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 315 W PONCE DE LEON AVE STE 546
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City | DECATUR
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State | GA
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Zip | 30030-2448
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Country | US
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Telephone | 404-997-8043
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Fax | 949-757-8783
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Provider Business Mailing Address
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Address Line | 207 VAN NESS
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2134
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Country | US
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Telephone | 706-350-9954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 261236
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License Number State | GA
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