MEDICARE: DR. SUSAN DAVIS EMMETT 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	207Y00000X	Otolaryngology Physician	116601	AK
2	207Y00000X	Otolaryngology Physician	D0082644	MD
3	207Y00000X	Otolaryngology Physician	2017-00540	NC

General Provider Information

NPI Number	:	1639498934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN DAVIS EMMETT MD

Provider Business Mailing Address
First Line	:	BOX 3805 MED CTR
Second Line	:	DUMC
City	:	DURHAM
State	:	NC
Zip	:	27710
Country	:	US
Telephone Number	:	919-684-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 JACK STEPHENS DR # 547-05
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-5551
Country	:	US
Telephone Number	:	501-686-5878
Fax Number	:	501-686-8644

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/05/2022

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