Individual
KEVIN SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
936 WYNN RD, MCDONOUGH, GA 30252-5802
(404) 314-4754
Mailing address
936 WYNN RD, MCDONOUGH, GA 30252-5802
(404) 314-4754
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT002677
GA
Other
Enumeration date
07/22/2016
Last updated
07/22/2016
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