Healthcare Provider Details

I. General information

NPI: 1548654411
Provider Name (Legal Business Name): DONECIA PERRIN-SULLIVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 SHARTOM DR
AUGUSTA GA
30907-4751
US

IV. Provider business mailing address

524 SHARTOM DR
AUGUSTA GA
30907-4751
US

V. Phone/Fax

Practice location:
  • Phone: 706-373-9184
  • Fax: 762-333-8798
Mailing address:
  • Phone: 706-373-9184
  • Fax: 762-333-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCO093014
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberCO093014
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: