Individual
GARY B SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1523 FAIR RD, STATESBORO, GA 30458-6025
(912) 871-2000
(912) 871-2500
Mailing address
PO BOX 1958, STATESBORO, GA 30459-1958
(912) 871-2000
(912) 871-2500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
30224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000353955C
—
GA
Enumeration date
04/11/2006
Last updated
03/31/2011
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