Provider Demographics
NPI:1104069962
Name:LAMB, SUSAN MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MICHELLE
Last Name:LAMB
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:032-967-3208
Mailing Address - Fax:803-293-7330
Practice Address - Street 1:3710 LANDMARK DR STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4034
Practice Address - Country:US
Practice Address - Phone:803-898-1470
Practice Address - Fax:803-898-1471
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37709208000000X, 2080C0008X
VA0101252470208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC377097Medicaid
SC37709OtherSC MEDICAL LICENSE
SCSC61562389Medicare PIN