MEDICARE: MS. SUSAN GAIL ADAMS APRN-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN120409	GA

General Provider Information

NPI Number	:	1003035734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN GAIL ADAMS APRN-BC

Provider Business Mailing Address
First Line	:	108 DOBBS DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-4637
Country	:	US
Telephone Number	:	706-354-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 BARNETT SHOALS RD
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30605-3625
Country	:	US
Telephone Number	:	706-542-7053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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