Individual
ROBERT EMMETT SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
115 N CENTRAL AVENUE, ADAIRSVILLE, GA 30103-2467
(470) 601-5650
(770) 877-3655
Mailing address
221 TECHNOLOGY PKWY NW, ROME, GA 30165-1369
(762) 235-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042742
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
925256491A
—
GA
05
—
925256491B
—
GA
Enumeration date
12/27/2006
Last updated
06/29/2021
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