Healthcare Provider Details

I. General information

NPI: 1487867115
Provider Name (Legal Business Name): ANICIA SULLIVAN BIGLOW APRN, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 17TH ST NW UNIT 2020
ATLANTA GA
30363-2000
US

IV. Provider business mailing address

390 17TH ST NW UNIT 2020
ATLANTA GA
30363-1018
US

V. Phone/Fax

Practice location:
  • Phone: 404-541-9699
  • Fax: 404-541-9698
Mailing address:
  • Phone: 404-541-9699
  • Fax: 404-541-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN058793
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: