MEDICARE: MICHAEL JAMES SULLIVAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	47161	GA

General Provider Information

NPI Number	:	1255341988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES SULLIVAN M.D.

Provider Business Mailing Address
First Line	:	3025 SHRINE RD
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4784
Country	:	US
Telephone Number	:	912-466-7340
Fax Number	:	912-466-7358

Provider Business Practice Location Address
First Line	:	3025 SHRINE RD
Second Line	:
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4784
Country	:	US
Telephone Number	:	912-466-7340
Fax Number	:	912-466-7358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	01/05/2016

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