Suzanne Channell, ATC, LAT, MBA

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT0262 Issued in MS

Practice address

104 McAuley Dr
Vicksburg, MS 39183-2825

Phone

(601) 883-6309

NPI assigned

Mar 24, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Credentials

Master of Business Administration

State licenses

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

{
    "created_epoch": "1174694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376660290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S FRONTAGE RD",
            "address_2": "APT 16A",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MCAULEY DR",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391832825",
            "telephone_number": "601-883-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANNELL",
        "first_name": "SUZANNE",
        "credential": "ATC, LAT, MBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MS",
            "license": "AT0262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Central Mississippi Civic Improvement Association, Inc (Jackson Hinds Comprehensive Health Center)
• Central Mississippi Medical Clinic PLLC
• Central Mississippi Prevention Services Inc
• Central Mississippi Vascular Care, LLC (Central Mississippi Vascular Care)
• Martin V Chaney, D.M.D.
• Kathleen Chappelear, LCSW
• Linda Cheslek
• Michael Chester, PTA
• Susan A Chiarito, MD
• Albert F Chiemprabha, MD

• Athletic Trainer in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Athletic Trainer in Mississippi

• 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.