Individual
SUSAN BARBARA REDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
(843) 347-5060
Mailing address
1102 OSPREY CT, MURRELLS INLET, SC 29576-8702
(843) 651-2150
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
27527
SC
2084P0800X
Psychiatry Physician
4301072829
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327877
—
SC
Enumeration date
07/19/2006
Last updated
02/07/2013
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