Organization
RADIOLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BILLY L. SULLIVAN M. D. (OWNER/PARTNER)
(662) 328-8404
Entity
Organization
Contact information
Practice address
2400 5TH ST N, COLUMBUS, MS 39705-2000
(662) 328-8404
(662) 329-4645
Mailing address
2400 5TH ST N, COLUMBUS, MS 39705-2000
(662) 328-8404
(662) 329-4645
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
04908
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09010990
—
MS
01
—
411589514
BLUE CROSS OF MS
MS
Enumeration date
09/20/2006
Last updated
06/25/2008
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