Active NPI
Susan Lanette Booth
- Pharmacist
- Roswell, GA
National Provider Identifier
1255451704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 021015
- Practice address
- 2350 Holcomb Bridge Rd
Roswell, GA 30076-3408 - Phone
- (770) 642-1829
- NPI assigned
- Mar 29, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 021015 | GA | Primary |
Addresses
Primary practice location
2350 Holcomb Bridge Rd
Roswell, GA 30076-3408
Mailing address
4310 Flippen TRL
Norcross, GA 30092-3902
Phone (770) 613-0764
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 021015 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255451704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4310 FLIPPEN TRL",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300923902",
"telephone_number": "770-613-0764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2350 HOLCOMB BRIDGE RD",
"city": "ROSWELL",
"state": "GA",
"postal_code": "300763408",
"telephone_number": "770-642-1829"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "SUSAN",
"middle_name": "LANETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "021015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roswell, GA
Sources for this page
- 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.