Individual
MISS THEA DELORA SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3628 RIVER HEIGHTS XING SE, MARIETTA, GA 30067-4870
(770) 272-0716
Mailing address
3628 RIVER HEIGHTS XING SE, MARIETTA, GA 30067-4870
(770) 272-0716
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
Primary
RN196107
GA
Other
Enumeration date
04/07/2009
Last updated
04/07/2009
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