# KEVIN L. SULLIVAN MD, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750551834
- **Authorized official:** DR. KEVIN L. SULLIVAN MD (MD)
- **Authorized official phone:** (404) 377-9171

## Contact information

- **Practice address:** 250 E PONCE DE LEON AVE, DECATUR, GA 30030-3440
- **Practice address phone:** (404) 377-9171
- **Practice address fax:** (404) 977-9172
- **Mailing address:** 40 VALLEY STREAM PKWY, STE 100, MALVERN, PA 19355-1407
- **Mailing address phone:** (610) 644-8900
- **Mailing address fax:** (484) 924-0053

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2008
- **Last updated:** 10/20/2016