Individual
DR. KEVIN L. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 PONCE DE LEON AVE, SUITE 100, DECATUR, GA 30030-3406
(404) 377-9171
(404) 377-9172
Mailing address
182 INDUSTRIAL ROAD, GLEN ROCK, PA 17327-8626
(717) 235-9352
(717) 235-4024
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
MD027085E
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
053430
GA
2085R0204X
Vascular & Interventional Radiology Physician
MD027085E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409020411I
—
GA
Enumeration date
07/14/2006
Last updated
07/27/2012
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