Healthcare Provider Details

I. General information

NPI: 1285259754
Provider Name (Legal Business Name): JAMES DEAL SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 NACOOCHEE AVE
ATHENS GA
30601-1823
US

IV. Provider business mailing address

150 NACOOCHEE AVE
ATHENS GA
30601-1823
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-7908
  • Fax: 706-546-1944
Mailing address:
  • Phone: 706-546-7908
  • Fax: 706-546-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number103595
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: