Provider Demographics
NPI:1528463627
Name:SUGGS, JAVARIS LAMAR
Entity type:Individual
Prefix:
First Name:JAVARIS
Middle Name:LAMAR
Last Name:SUGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 OWLS HEAD DR
Mailing Address - Street 2:APT P
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-8756
Mailing Address - Country:US
Mailing Address - Phone:260-804-3637
Mailing Address - Fax:
Practice Address - Street 1:6611 OWLS HEAD DR
Practice Address - Street 2:APT P
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-8756
Practice Address - Country:US
Practice Address - Phone:260-804-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201116530AMedicaid