MEDICARE: MRS. BARBARA LEE ANNE SUSIN C.N.M.

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	367A00000X	Advanced Practice Midwife	ARNP9226657	FL
2	367A00000X	Advanced Practice Midwife	RN116490	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	:	1346234903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA LEE ANNE SUSIN C.N.M.

Provider Business Mailing Address
First Line	:	4181 HOSPITAL DR NE STE 104
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2541
Country	:	US
Telephone Number	:	770-385-8954
Fax Number	:	770-385-8590

Provider Business Practice Location Address
First Line	:	4181 HOSPITAL DR NE STE 104
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30014-2541
Country	:	US
Telephone Number	:	770-385-8954
Fax Number	:	770-385-8590

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/09/2014

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