Provider Demographics
NPI:1568048684
Name:MUGGAR, SUE DIAMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:DIAMOND
Last Name:MUGGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUE
Other - Middle Name:DIAMOND
Other - Last Name:STAZETSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:144 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-2860
Mailing Address - Country:US
Mailing Address - Phone:478-412-0411
Mailing Address - Fax:478-476-8397
Practice Address - Street 1:350 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-765-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA948232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry