Healthcare Provider Details

I. General information

NPI: 1508843087
Provider Name (Legal Business Name): JACQUELINE L SUGG RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

IV. Provider business mailing address

201 GOVERNMENT CIR
GREENVILLE NC
27834-8198
US

V. Phone/Fax

Practice location:
  • Phone: 252-902-2418
  • Fax: 252-413-1446
Mailing address:
  • Phone: 252-902-2418
  • Fax: 252-413-1446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL002211
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: