Provider Demographics
NPI:1871592287
Name:LOWRY, SUSAN S (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:S
Last Name:LOWRY
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 1:117 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3309
Mailing Address - Country:US
Mailing Address - Phone:731-587-9511
Mailing Address - Fax:877-309-6416
Practice Address - Street 1:117 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3394
Practice Address - Country:US
Practice Address - Phone:731-587-9511
Practice Address - Fax:877-309-6416
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD26758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3091111Medicaid
2646506OtherAMERIGROUP
5281135OtherAETNA
TN3028491OtherBLUE CROSS BLUE SHIELD
TN116805OtherUNISON HEALTH PLANS
080096627Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN301112Medicaid