Provider Demographics
NPI:1194505701
Name:LAIRD, SUSAN K (DNP, MSN, RN)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:LAIRD
Suffix:
Gender:F
Credentials:DNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 COUNTRY SQUIRE CT
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1812
Mailing Address - Country:US
Mailing Address - Phone:770-377-3418
Mailing Address - Fax:
Practice Address - Street 1:1504 COUNTRY SQUIRE CT
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1812
Practice Address - Country:US
Practice Address - Phone:770-377-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135523163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse