Individual
MALLORY BREANNA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3050
(404) 616-1000
Mailing address
2222 E WEST CONNECTOR APT 121, AUSTELL, GA 30106-8189
(404) 844-1162
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN289418
GA
Other
Enumeration date
11/12/2019
Last updated
11/11/2022
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