Healthcare Provider Details

I. General information

NPI: 1306423132
Provider Name (Legal Business Name): JOEL BRENT SULLIVAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 CHAMPIONS BLVD STE 102
AUBURN AL
36830-6471
US

IV. Provider business mailing address

2375 CHAMPIONS BLVD STE 102
AUBURN AL
36830-6471
US

V. Phone/Fax

Practice location:
  • Phone: 334-528-6320
  • Fax:
Mailing address:
  • Phone: 334-528-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO.3051
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: