Provider Demographics
NPI:1992149215
Name:SUGGS, JOSHUA A (PA-C)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:SUGGS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 THREE RIVERS DR NE
Mailing Address - Street 2:STE A
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4999
Mailing Address - Country:US
Mailing Address - Phone:706-292-0040
Mailing Address - Fax:706-378-0556
Practice Address - Street 1:100 THREE RIVERS DR NE
Practice Address - Street 2:STE A
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4999
Practice Address - Country:US
Practice Address - Phone:706-292-0040
Practice Address - Fax:706-378-0556
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2478363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
2478OtherGEORGIA LICENSE