Organization
SULLIVAN PROFESSIONAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LATASHA GWENETTE SULLIVAN (MANAGING DIRECTOR)
(864) 209-5208
Entity
Organization
Contact information
Practice address
9 HOGAN DR, GREENVILLE, SC 29605-5909
(864) 209-5208
Mailing address
9 HOGAN DR, GREENVILLE, SC 29605-5909
(864) 209-5208
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871182642
—
SC
Enumeration date
02/01/2021
Last updated
02/01/2021
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