Provider Demographics
NPI:1386622009
Name:NEAL, SUZAN YVETTE (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:SUZAN
Middle Name:YVETTE
Last Name:NEAL
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 26TH ST NW
Mailing Address - Street 2:UNIT 107
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2076
Mailing Address - Country:US
Mailing Address - Phone:404-786-6656
Mailing Address - Fax:404-733-6098
Practice Address - Street 1:130 26TH ST NW
Practice Address - Street 2:UNIT 107
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2076
Practice Address - Country:US
Practice Address - Phone:404-786-6656
Practice Address - Fax:404-733-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115041364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA284956346CMedicaid
GA89BBBLDMedicare ID - Type Unspecified
GA89BBBCRMedicare ID - Type UnspecifiedMEDICARE
GA89BBBGTMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER