Provider Demographics
NPI:1366419905
Name:SUGGS, JACQUELINE M (PTA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:SUGGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MESA VALLEY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8157
Mailing Address - Country:US
Mailing Address - Phone:678-309-8159
Mailing Address - Fax:678-309-8158
Practice Address - Street 1:2041 MESA VALLEY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8157
Practice Address - Country:US
Practice Address - Phone:678-309-8159
Practice Address - Fax:678-309-8158
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001634225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant