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NPI Code Detail

MEDICARE: SUSAN CAROL FLATT

MEDICARE: SUSAN CAROL FLATT
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
1106S00000XBehavior TechnicianRBT-20-142323TN

General Provider Information

NPI Number : 1760083794
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN CAROL FLATT
Provider Business Mailing Address
First Line : 415 HERITAGE HILLS CIR NE
Second Line :
City : CLEVELAND
State : TN
Zip : 37323-5156
Country : US
Telephone Number : 423-813-9326
Fax Number :
Provider Business Practice Location Address
First Line : 177 MOUSE CREEK RD NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3838
Country : US
Telephone Number : 423-813-9326
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 06/07/2024

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Directions to “ SUSAN CAROL FLATT ” Practice Location

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