Provider Demographics
NPI:1386981629
Name:SANNER, SUSAN (APRN-FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SANNER
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 PRISCILLA WAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2140
Mailing Address - Country:US
Mailing Address - Phone:770-961-4866
Mailing Address - Fax:770-961-4866
Practice Address - Street 1:2777 PRISCILLA WAY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2140
Practice Address - Country:US
Practice Address - Phone:770-961-4866
Practice Address - Fax:770-961-4866
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN079350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily