Provider Demographics
NPI:1447374459
Name:GILLETTE, SUSAN K (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:K
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 HAMPTON MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7006
Mailing Address - Country:US
Mailing Address - Phone:704-540-7552
Mailing Address - Fax:
Practice Address - Street 1:3604 HAMPTON MANOR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-7006
Practice Address - Country:US
Practice Address - Phone:704-540-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC260022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry