Provider Demographics
NPI:1073693016
Name:C RODNEY SUSONG MD PC
Entity type:Organization
Organization Name:C RODNEY SUSONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:SUSONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-870-3376
Mailing Address - Street 1:8115 ISLAND POINT DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341
Mailing Address - Country:US
Mailing Address - Phone:423-344-5029
Mailing Address - Fax:
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:STE 301A
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-870-3376
Practice Address - Fax:423-877-1387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty