MEDICARE: DR. SUSAN M HARDING 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	207R00000X	Internal Medicine Physician	31013	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
2	31013	OTHER	GA	STATE OF GA
3	498108	OTHER		BCBS

General Provider Information

NPI Number	:	1952396798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN M HARDING MD

Provider Business Mailing Address
First Line	:	PO BOX 148
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-0148
Country	:	US
Telephone Number	:	229-263-8956
Fax Number	:	229-263-4671

Provider Business Practice Location Address
First Line	:	905 N COURT ST
Second Line	:
City	:	QUITMAN
State	:	GA
Zip	:	31643-1362
Country	:	US
Telephone Number	:	229-263-8956
Fax Number	:	229-263-4671

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	11/05/2007

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