Individual
DR. REGINA MCCOLLUM SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1560 INDIAN TRAIL RD, SUITE 108, NORCROSS, GA 30093-2613
(770) 923-1011
(770) 923-1041
Mailing address
1560 INDIAN TRAIL RD, SUITE 108, NORCROSS, GA 30093-2666
(770) 923-1011
(770) 923-1041
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
GA1647
GA
152WC0802X
Corneal and Contact Management Optometrist
GA1647
GA
152WP0200X
Pediatric Optometrist
GA1647
GA
152WV0400X
Vision Therapy Optometrist
GA1647
GA
Other
Enumeration date
05/11/2006
Last updated
03/03/2008
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