Individual
ANNE LORRAINE SELF SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1520 UNION AVE, MEMPHIS, TN 38174-0275
(901) 276-2410
Mailing address
965 RIDGE LAKE BLVD STE 315, MEMPHIS, TN 38120-9401
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
29526
MS
207Q00000X
Family Medicine Physician
Primary
MD47894
TN
Other
Enumeration date
09/21/2005
Last updated
12/09/2021
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