Provider Demographics
NPI:1154317758
Name:SUGGS, MARY SUE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:SUGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 COGSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1243
Mailing Address - Country:US
Mailing Address - Phone:205-814-1598
Mailing Address - Fax:205-814-1587
Practice Address - Street 1:1508 COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1243
Practice Address - Country:US
Practice Address - Phone:205-814-1598
Practice Address - Fax:205-814-1587
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1052565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891001850Medicaid
AL051550183OtherBLUE CROSS BLUE SHIELD
AL891001850Medicaid
ALS44863Medicare UPIN