Provider Demographics
NPI:1285103747
Name:OLIVER, SUSAN KEYTON (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:KEYTON
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 US HIGHWAY 319 N
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-5435
Mailing Address - Country:US
Mailing Address - Phone:478-864-4205
Mailing Address - Fax:
Practice Address - Street 1:290 DONOVAN HARRISON RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-5045
Practice Address - Country:US
Practice Address - Phone:478-864-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF01180182363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty