Provider Demographics
NPI:1316151392
Name:BRITT, SUZANNE LIVENGOOD (PA-C, MPAS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LIVENGOOD
Last Name:BRITT
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:ELIZABETH
Other - Last Name:LIVENGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-1414
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-3892
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC858363AM0700X, 363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1421PAMedicaid
SCAA27309223Medicare PIN