Individual
LISA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
113 CONSTITUTION CT APT A, ALBANY, GA 31721-2150
(229) 364-5501
Mailing address
113 CONSTITUTION CT APT A, ALBANY, GA 31721-2150
(229) 364-5501
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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