Provider Demographics
NPI: | 1750308193 |
---|---|
Name: | SUGG, STEVEN M (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | STEVEN |
Middle Name: | M |
Last Name: | SUGG |
Suffix: | |
Gender: | M |
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: | 3000 SOUTHLAKE PARK |
Mailing Address - Street 2: | SUITE 100 |
Mailing Address - City: | BIRMINGHAM |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35244-3608 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 205-987-0724 |
Mailing Address - Fax: | 205-987-0725 |
Practice Address - Street 1: | 3000 SOUTHLAKE PARK |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | BIRMINGHAM |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35244-3608 |
Practice Address - Country: | US |
Practice Address - Phone: | 205-987-0724 |
Practice Address - Fax: | 205-987-0725 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-15 |
Last Update Date: | 2022-12-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 053883 | 2084P0800X, 2084P0804X |
AL | 32838 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
I65572 | Medicare UPIN |