Individual
KEVIN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
541 HISTORIC HIGHWAY 441, DEMOREST, GA 30535
(706) 839-4000
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301106158
MI
208M00000X
Hospitalist Physician
Primary
82648
GA
Other
Enumeration date
07/01/2014
Last updated
08/19/2019
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