Provider Demographics
NPI:1457341190
Name:MACKEY, SUSAN EADES (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:EADES
Last Name:MACKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BELLE MEADE BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4508
Mailing Address - Country:US
Mailing Address - Phone:615-403-9704
Mailing Address - Fax:
Practice Address - Street 1:1212 BELLE MEADE BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-4508
Practice Address - Country:US
Practice Address - Phone:615-403-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27150207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3094264Medicaid
TN3094268Medicare ID - Type Unspecified
TNF59828Medicare UPIN