MEDICARE: DR. SUSAN H LAND 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	46878	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

General Provider Information

NPI Number	:	1215935903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN H LAND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2510
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-2510
Country	:	US
Telephone Number	:	706-922-8251
Fax Number	:	706-922-6695

Provider Business Practice Location Address
First Line	:	505 MOUNT PLEASANT RD
Second Line	:
City	:	THOMSON
State	:	GA
Zip	:	30824-8140
Country	:	US
Telephone Number	:	706-595-1461
Fax Number	:	706-597-9824

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/21/2024

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