Active NPI
Susan H Kirby, NP-C
- Nurse Practitioner
- Austell, GA
National Provider Identifier
1154533875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN157966
- Practice address
- 2041 Mesa Valley Way
Suite 100
Austell, GA 30106-6828 - Phone
- (770) 944-1100
- Fax
- (770) 944-6469
- NPI assigned
- May 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | F0207056 | GA | |
| Nurse Practitioner | 363L00000X | RN157966 | GA | Primary |
Addresses
Primary practice location
2041 Mesa Valley Way
Suite 100
Austell, GA 30106-6828
Mailing address
2041 Mesa Valley Way
Suite 100
Austell, GA 30106-6828
Phone (770) 944-1100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 475644168A | Medicaid | GA | |
| 475644168B | Medicaid | GA | |
| 475644168C | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F0207056 | GA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resurgens, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1233792000000",
"number": "1154533875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2041 MESA VALLEY WAY",
"address_2": "SUITE 100",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301066828",
"telephone_number": "770-944-1100",
"fax_number": "770-944-6469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2041 MESA VALLEY WAY",
"address_2": "SUITE 100",
"city": "AUSTELL",
"state": "GA",
"postal_code": "301066828",
"telephone_number": "770-944-1100",
"fax_number": "770-944-6469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "SUSAN",
"middle_name": "H",
"name_prefix": "Ms.",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-04",
"last_updated": "2009-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "F0207056",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "GA",
"license": "RN157966",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "475644168A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "475644168B",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "475644168C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austell, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.