Individual
SABRA SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D., PHD.
Contact information
Practice address
501 MARSHALL ST, SUITE 606, JACKSON, MS 39202-1651
(601) 355-8555
(601) 355-2244
Mailing address
501 MARSHALL ST, SUITE 606, JACKSON, MS 39202-1651
(601) 355-8555
(601) 355-2244
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
14238
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0114928
—
MS
Enumeration date
03/01/2006
Last updated
06/14/2010
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