Individual
STEPHANIE TIV SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1230 BALD RIDGE MARINA RD STE 300, CUMMING, GA 30041-7859
(770) 814-8222
(678) 205-5111
Mailing address
PO BOX 23329, NEW YORK, NY 10087-3329
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/06/2013
Last updated
03/31/2026
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