Provider Demographics
NPI:1114938149
Name:OCONNOR, SUSAN MCANELLY (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCANELLY
Last Name:OCONNOR
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 1:6965 STONE RUN DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8537
Mailing Address - Country:US
Mailing Address - Phone:615-832-6055
Mailing Address - Fax:
Practice Address - Street 1:460 9TH AVE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2010
Practice Address - Country:US
Practice Address - Phone:615-459-6811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD82402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506120Medicaid
CAWC50612AMedicare PIN
CAB02765Medicare UPIN