Provider Demographics
NPI:1649689449
Name:BROWN, SUZANNE ELIZABETH (RN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1109 BURLEYSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3094
Mailing Address - Country:US
Mailing Address - Phone:706-259-3336
Mailing Address - Fax:706-370-7715
Practice Address - Street 1:1109 BURLEYSON RD
Practice Address - Street 2:STE 202
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3094
Practice Address - Country:US
Practice Address - Phone:706-259-3336
Practice Address - Fax:706-370-7715
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA174936363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031523754AMedicaid
GA02548767OtherAMERIGROUP
GA1028078OtherWELLCARE
GA02548767OtherAMERIGROUP