Provider Demographics
NPI:1780670752
Name:SUGGS, WILLIAM JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAY
Last Name:SUGGS
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:P.O. BOX 1029
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1029
Mailing Address - Country:US
Mailing Address - Phone:256-355-6414
Mailing Address - Fax:256-355-6646
Practice Address - Street 1:1405 7TH STREET SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601
Practice Address - Country:US
Practice Address - Phone:256-355-6414
Practice Address - Fax:256-355-6646
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025766208600000X
AL25766208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529923070Medicaid
AL009943036Medicaid
AL529923070Medicaid
AL051540125Medicare PIN
ALG84242Medicare UPIN
AL051526863SUGMedicare ID - Type UnspecifiedMEDICARE