Susan Denise Tackett, CPED

Primary specialty

ContractorTaxonomy code 171W00000X

Practice address

696 Breedlove Dr
Suite B5
Monroe, GA 30655-2052

Phone

(404) 713-7011

Fax

(770) 207-7196

NPI assigned

Oct 1, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063505352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 APALACHEE RDG",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306568535",
            "telephone_number": "404-713-7011",
            "fax_number": "770-207-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "696 BREEDLOVE DR",
            "address_2": "SUITE B5",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552052",
            "telephone_number": "404-713-7011",
            "fax_number": "770-207-7196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "SUSAN",
        "middle_name": "DENISE",
        "name_prefix": "Mrs.",
        "credential": "CPED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Bridge of Georgia Center Inc.
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• Contractor in Monroe, GA
• Providers in Monroe, GA by specialty
• Contractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.