Individual
JERRY SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2225 US HIGHWAY 41 N, TIFTON, GA 31794-2749
(229) 391-4100
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 391-4100
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004285
GA
Other
Enumeration date
09/02/2005
Last updated
04/06/2021
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