Provider Demographics
NPI:1396799193
Name:BECKETT, SUSAN ANNETTE (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANNETTE
Last Name:BECKETT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1704
Mailing Address - Country:US
Mailing Address - Phone:404-255-1930
Mailing Address - Fax:404-459-8510
Practice Address - Street 1:314 STEWART ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-9810
Practice Address - Country:US
Practice Address - Phone:206-347-1300
Practice Address - Fax:206-347-1275
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN152959 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ44917Medicare UPIN