Provider Demographics
NPI:1053720441
Name:YATES, SUSAN MARINA (NP-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARINA
Last Name:YATES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:MARINA
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1525 CHATTANOOGA RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8379
Mailing Address - Country:US
Mailing Address - Phone:706-529-7124
Mailing Address - Fax:706-529-7126
Practice Address - Street 1:1525 CHATTANOOGA RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8379
Practice Address - Country:US
Practice Address - Phone:706-529-7124
Practice Address - Fax:706-529-7126
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32978363LF0000X
GA105921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I509272Medicare PIN
GA202I500788Medicare PIN
GA003150985AMedicaid
GA003150985BMedicaid
GA003150985EMedicaid
GA003150985FMedicaid
GA003150985DMedicaid