Individual provider Active NPI

Susan T Thisell, CNS

  • Psychiatry Physician
  • Augusta, GA
National Provider Identifier
1528043064
Registry record updated Oct 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
RN082980 Issued in GA
Practice address
3421 Mike Padgett Hwy
Augusta, GA 30906-3815
Phone
(706) 432-4858
Fax
(706) 432-3780
NPI assigned
Dec 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X RN082980 GA Primary

Addresses

Primary practice location

3421 Mike Padgett Hwy
Augusta, GA 30906-3815

Mailing address

3421 Mike Padgett Hwy
Augusta, GA 30906-3815
Phone (706) 432-4858

Other identifiers 1

IdentifierTypeStateIssuer
000606317BMedicaidGA

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
Credentials
Certified Nurse Specialist

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256688000000",
    "number": "1528043064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3421 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-432-4858",
            "fax_number": "706-432-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3421 MIKE PADGETT HWY",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309063815",
            "telephone_number": "706-432-4858",
            "fax_number": "706-432-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THISELL",
        "first_name": "SUSAN",
        "middle_name": "T",
        "credential": "CNS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-07",
        "last_updated": "2009-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "RN082980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000606317B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.

Verify at the official NPI Registry.