Individual
SPENCER K SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7730 OLD CANTON RD BLDG B, MADISON, MS 39110-9299
(601) 499-0935
(601) 499-0936
Mailing address
7731 OLD CANTON RD STE B, MADISON, MS 39110-6115
(601) 499-0935
(601) 499-0936
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
23304
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01212067
—
MS
Enumeration date
05/02/2007
Last updated
04/14/2025
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