Provider Demographics
NPI:1124061700
Name:GOLDSMITH, SUSAN LYNN (MSN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 LAKESHORE DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3875
Mailing Address - Country:US
Mailing Address - Phone:912-576-7546
Mailing Address - Fax:912-576-2348
Practice Address - Street 1:102 LAKESHORE DR STE B
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3875
Practice Address - Country:US
Practice Address - Phone:912-576-7546
Practice Address - Fax:912-576-2348
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211812363LP2300X, 363LF0000X, 207Q00000X, 261QP2300X, 363LP2300X
FLAPRN9331191363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208976308Medicaid
P04643Medicare UPIN
MO208976308Medicaid