Organization
SULLIVAN PSYCHIATRIC SVCS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAINA SULLIVAN MD (OWNER)
(404) 508-3822
Entity
Organization
Contact information
Practice address
425 ALLGOOD RD, STONE MOUNTAIN, GA 30083-6145
(404) 508-3822
(404) 508-3823
Mailing address
425 ALLGOOD RD, STONE MOUNTAIN, GA 30083-6145
(404) 508-3822
(404) 508-3823
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
047162
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343324511A
—
GA
Enumeration date
09/28/2009
Last updated
09/28/2009
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