Active NPI
M. Avigail Susson, P.T.
- Physical Therapist
- Stockbridge, GA
National Provider Identifier
1356575203
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT009507
- Practice address
- 675 Southcrest Pkwy
Suite 150
Stockbridge, GA 30281-7973 - Phone
- (678) 251-1280
- Fax
- (678) 251-1284
- NPI assigned
- May 6, 2009
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT009507 | GA | Primary |
Addresses
Primary practice location
675 Southcrest Pkwy
Suite 150
Stockbridge, GA 30281-7973
Mailing address
675 Southcrest Pkwy
Suite 150
Stockbridge, GA 30281-7973
Phone (678) 251-1280
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 |
|---|---|---|---|
| PT009507 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1241568000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366156800000",
"number": "1356575203",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "675 SOUTHCREST PKWY",
"address_2": "SUITE 150",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302817973",
"telephone_number": "678-251-1280",
"fax_number": "678-251-1284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "675 SOUTHCREST PKWY",
"address_2": "SUITE 150",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302817973",
"telephone_number": "678-251-1280",
"fax_number": "678-251-1284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSSON",
"first_name": "M.",
"middle_name": "AVIGAIL",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-05-06",
"last_updated": "2013-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT009507",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.