Provider Demographics
NPI:1598028060
Name:GOODMAN, SUSANNAH BURNS (NP)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:BURNS
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:GA
Mailing Address - Zip Code:30206-2903
Mailing Address - Country:US
Mailing Address - Phone:404-664-7264
Mailing Address - Fax:
Practice Address - Street 1:6070 LAKESIDE COMMONS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5778
Practice Address - Country:US
Practice Address - Phone:478-254-2644
Practice Address - Fax:478-254-4924
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN157565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily