MEDICARE: SUSAN BUTLER-SUMNER M.D.

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	207Q00000X	Family Medicine Physician	01201822021	GA
2	207Q00000X	Family Medicine Physician	29851	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205896305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BUTLER-SUMNER M.D.

Provider Business Mailing Address
First Line	:	28 ROME RD
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-0000
Country	:	US
Telephone Number	:	706-777-8775
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 ROME RD
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-0000
Country	:	US
Telephone Number	:	706-777-8775
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	01/24/2023

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