Provider Demographics
NPI:1548256084
Name:RAISOR, SUSANNE (CRNA)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:RAISOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 NOAH DR
Mailing Address - Street 2:SUITE 113-315
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-8705
Mailing Address - Country:US
Mailing Address - Phone:706-301-1098
Mailing Address - Fax:706-301-9151
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4872
Practice Address - Country:US
Practice Address - Phone:706-692-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052516367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA917455OtherBCBS PROVIDER NUM
GA000547335CMedicaid
GAP00137037OtherRR MEDICARE PROVIDER NUM
GAP00137037OtherRR MEDICARE PROVIDER NUM
GA43ZCBZS01Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE