Basic Information
| Provider Information | |||||||||
| NPI: | 1760912596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFORD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FISHER | ||||||||
| OtherFirstName: | SUSAN | ||||||||
| OtherMiddleName: | ASHLEY | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 925 WIMBLEDON RD | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312108221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785500274 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6005 WATSON BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BYRON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310086542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789565002 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN227426 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.