Individual
MRS. CASSANDRA MICHELLE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1926 THOMAS LANE AUGUSTA, GA, AUGSTA, GA 30815-3081
(706) 910-2727
Mailing address
1926 THOMAS LN, AUGUSTA, GA 30904-5114
(706) 910-2725
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
ADC000309
GA
Other
Enumeration date
09/08/2022
Last updated
09/08/2022
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