Provider Demographics
NPI:1194873828
Name:LOMAX, SUSAN E (CPNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LOMAX
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 FRANKLIN RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-7803
Mailing Address - Country:US
Mailing Address - Phone:770-732-6007
Mailing Address - Fax:770-732-8242
Practice Address - Street 1:777 FRANKLIN RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-7803
Practice Address - Country:US
Practice Address - Phone:770-732-6007
Practice Address - Fax:770-732-8242
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA117846363LP0200X
GARN117846363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11194873828OtherNPI
GA818552480AOtherMEDICAID PAYEE ID
GA818552480AMedicaid
GA000874057IMedicaid
GA818552480AMedicaid
GA$$$$$$$$$Medicaid