Individual
MR. KENNETH W SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3511 OLD CLARKSVILLE PIKE, JOELTON, TN 37080-8892
(615) 299-5341
(615) 299-5386
Mailing address
PO BOX 57, SPRINGFIELD, TN 37172-0057
(615) 299-5341
(615) 299-5386
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27509
TN
Other
Enumeration date
10/03/2006
Last updated
06/09/2015
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