MEDICARE: DR. SUSAN G TRAXLER 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	208000000X	Pediatrics Physician	052376	GA

General Provider Information

NPI Number	:	1700922747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN G TRAXLER MD

Provider Business Mailing Address
First Line	:	5400 LAUREL SPRINGS PKWY
Second Line	:	SUITE 1402
City	:	SUWANEE
State	:	GA
Zip	:	30024-6056
Country	:	US
Telephone Number	:	678-965-0586
Fax Number	:	877-500-8092

Provider Business Practice Location Address
First Line	:	5400 LAUREL SPRINGS PKWY
Second Line	:	SUITE 1402
City	:	SUWANEE
State	:	GA
Zip	:	30024-6056
Country	:	US
Telephone Number	:	678-965-0586
Fax Number	:	877-500-8092

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	03/18/2016

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