Suezan C. McCormick, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

262691 Issued in MS

Practice address

115 Hwy 556
Meadville, MS 39653

Phone

(601) 384-5891

Fax

(601) 384-5878

NPI assigned

Jan 16, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417008103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "MEADVILLE",
            "state": "MS",
            "postal_code": "396530758",
            "telephone_number": "601-384-5891",
            "fax_number": "601-384-5878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 HWY 556",
            "city": "MEADVILLE",
            "state": "MS",
            "postal_code": "39653",
            "telephone_number": "601-384-5891",
            "fax_number": "601-384-5878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "SUEZAN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "262691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00060449",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Honeysuckle Village Specialty Center LLC
• Dana Lynn Jackson, LPTA
• Mallory De Johnson
• William B Larkin Jr., MD
• Patricia McClain, NP
• Meadville LLC (Meadville Convalescent Home)
• Jennifer Meilstrup, CPNP
• Michael T Milstead, PHARMD
• Carol Ann Oglesby, B.A., M.S./CCC/SLP
• Sarah Gayle Oliver, NP

• General Practice Dentistry in Meadville, MS
• Providers in Meadville, MS by specialty
• General Practice Dentistry 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.