Provider Demographics
NPI:1154341543
Name:HARLOW, SUSAN B (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:HARLOW
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 1:597 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-7540
Mailing Address - Country:US
Mailing Address - Phone:931-815-6000
Mailing Address - Fax:931-815-6006
Practice Address - Street 1:597 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-7540
Practice Address - Country:US
Practice Address - Phone:931-815-6000
Practice Address - Fax:931-815-6006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0104OtherAMERICHOICE
TN1512478Medicaid
TN4222211OtherBLUE CROSS BLUE SHIELD OF TN
TNF01496Medicare UPIN
TN1512478Medicaid