Active NPI
Suzanne Rachel Nelson, PA-C
- Physician Assistant
- Kennesaw, GA
National Provider Identifier
1639464902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6156
- Practice address
- 750 Town Park Lane
Kaiser Permanente Town Park Medical Center
Kennesaw, GA 30144 - Phone
- (404) 352-1053
- Fax
- (404) 350-0840
- NPI assigned
- Jun 15, 2011
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6156 | GA | Primary |
Addresses
Primary practice location
750 Town Park Lane
Kaiser Permanente Town Park Medical Center
Kennesaw, GA 30144
Mailing address
3495 Piedmont Road, NE
Nine Piedmont Center
Atlanta, GA 30305
Phone (404) 364-7070
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6156 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396483200000",
"number": "1639464902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3495 PIEDMONT ROAD, NE",
"address_2": "NINE PIEDMONT CENTER",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30305",
"telephone_number": "404-364-7070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 TOWN PARK LANE",
"address_2": "KAISER PERMANENTE TOWN PARK MEDICAL CENTER",
"city": "KENNESAW",
"state": "GA",
"postal_code": "30144",
"telephone_number": "404-352-1053",
"fax_number": "404-350-0840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "SUZANNE",
"middle_name": "RACHEL",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-15",
"last_updated": "2014-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "6156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.