Individual
MICHAEL JOHN SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGANP-C
Contact information
Practice address
705 DIXIE ST, SUITE 401, CARROLLTON, GA 30117-3818
(770) 836-9326
Mailing address
119 AMBULANCE DR, SUITE 202, CARROLLTON, GA 30117-3857
(770) 838-8710
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN209135
GA
363LG0600X
Gerontology Nurse Practitioner
RN209135
GA
Other
Enumeration date
02/23/2016
Last updated
03/02/2016
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