Individual
DR. JENNIFER ELLEN SUSORENY-VELGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1600 VERNON RD STE A, LAGRANGE, GA 30240-4143
(706) 880-7321
Mailing address
1600 VERNON RD STE A, LAGRANGE, GA 30240-4143
(706) 880-7321
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
99331
GA
208600000X
Surgery Physician
E-10631
AR
208600000X
Surgery Physician
OS-18050
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221624003
—
AR
Enumeration date
04/30/2012
Last updated
01/22/2025
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