Individual
SUSANNE RAISOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1266 HIGHWAY 515 S, JASPER, GA 30143-4872
(706) 692-2441
Mailing address
744 NOAH DR, SUITE 113-315, JASPER, GA 30143-8705
(706) 301-1098
(706) 301-9151
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN052516
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000547335C
—
GA
01
—
917455
BCBS PROVIDER NUM
GA
01
—
P00137037
RR MEDICARE PROVIDER NUM
GA
Enumeration date
09/20/2005
Last updated
11/11/2013
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