Organization
HEEERS, PA
Active
Other names
Sullivan Family Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HURSIE J DAVIS-SULLIVAN M.D. (OWNER AND PRESIDENT)
(601) 373-2940
Entity
Organization
Contact information
Practice address
1814 HOSPITAL DR, JACKSON, MS 39204-3410
(601) 373-2940
(601) 373-2720
Mailing address
1814 HOSPITAL DR, JACKSON, MS 39204-3410
(601) 373-2940
(601) 373-2720
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
13888
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112110
—
MS
05
—
08236531
—
MS
Enumeration date
06/23/2005
Last updated
11/09/2010
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