Individual
DR. JOHN MAGRUDER SULLIVAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
37 ENCLAVE CIR, RIDGELAND, MS 39157-4522
(601) 953-3304
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
T-3879
MS
Other
Enumeration date
07/01/2019
Last updated
07/01/2019
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