Individual
SUSAN BROWN ORCUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
403 W MAIN ST, THOMASTON, GA 30286-3503
(706) 646-2888
Mailing address
2670 EMERALD DR, JONESBORO, GA 30236-5232
(404) 323-5661
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004483
GA
363AS0400X
Surgical Physician Assistant
004483
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
376314055A
—
GA
01
—
P00927564
RR MEDICARE
GA
Enumeration date
07/07/2006
Last updated
02/21/2017
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