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Individual

SUSAN CONWAY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
206 E FARREL RD STE 270, LAFAYETTE, LA 70508-7104
(337) 989-8795
(404) 843-0812
Mailing address
5445 MERIDIAN MARKS RD NE, SUITE 270, ATLANTA, GA 30342-4763
(404) 843-2229
(404) 843-0812

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
54192
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
54192
GA STATE LICENSE
GA
Enumeration date
01/28/2006
Last updated
12/14/2020
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