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General NPI Number Information
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NPI Number | 1881920734
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Entity Type | Individual
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Provider Name | SUSAN NEIDLINGER HARRISON NP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 1451 GA HIGHWAY 21 S H
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City | SPRINGFIELD
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State | GA
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Zip | 31329-5244
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Country | US
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Telephone | 912-754-1035
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 386
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City | SPRINGFIELD
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State | GA
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Zip | 31329-0386
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Country | US
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Telephone | 912-754-6451
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN113434NP
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License Number State | GA
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