Basic Information
Provider Information
NPI: 1326543596
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SUGGS
FirstName: MATTHEW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5750A SOUTHLAND DR
Address2:  
City: MOBILE
State: AL
PostalCode: 366933316
CountryCode: US
TelephoneNumber: 2514505916
FaxNumber: 2516627297
Practice Location
Address1: 374 GREENO RD S
Address2:  
City: FAIRHOPE
State: AL
PostalCode: 365321916
CountryCode: US
TelephoneNumber: 2514502211
FaxNumber: 2516627297
Other Information
ProviderEnumerationDate: 03/28/2018
LastUpdateDate: 09/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X ALN Student, Health CareStudent in an Organized Health Care Education/Training Program 
2084P0800XDO.2147ALY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


Home