Individual
MRS. SARAH HAZLEGROVE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
711 JEFFERSON AVE, MEMPHIS, TN 38105-5003
(901) 448-6511
(901) 448-7097
Mailing address
711 JEFFERSON AVE, MEMPHIS, TN 38105-5003
(901) 448-6511
(901) 448-7097
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
LDN2202
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I711459
MEDICARE PTAN
TN
05
—
1519010
—
TN
Enumeration date
02/01/2010
Last updated
09/26/2012
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