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Individual

DR. TIMOTHY JAMES SULLIVAN JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 587-5571
(423) 587-5237
Mailing address
1021 W OAKLAND AVE, SUITE 207, JOHNSON CITY, TN 37604-2191
(423) 915-3104
(423) 952-3109

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD18502
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3882277
TN
Enumeration date
07/20/2005
Last updated
01/13/2009
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