MEDICARE: MRS. SUSAN DAVIDSON ROLLINS MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD0000020455	TN
2	207ZC0500X	Cytopathology Physician	MD0000020455	TN

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	:	1578546370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN DAVIDSON ROLLINS MD

Provider Business Mailing Address
First Line	:	2400 SUSANNAH ST STE A
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1730
Country	:	US
Telephone Number	:	423-283-4734
Fax Number	:	423-283-4736

Provider Business Practice Location Address
First Line	:	2400 SUSANNAH ST STE A
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-1730
Country	:	US
Telephone Number	:	423-283-4734
Fax Number	:	423-283-4736

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

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	10/28/2020

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