Healthcare Provider Details

I. General information

NPI: 1114683984
Provider Name (Legal Business Name): SULLIVAN BUERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 AUTUMN SPRINGS CT STE 28
FRANKLIN TN
37067-2849
US

IV. Provider business mailing address

2383 SOMERSET VALLEY DR
ANTIOCH TN
37013-4584
US

V. Phone/Fax

Practice location:
  • Phone: 256-655-6450
  • Fax:
Mailing address:
  • Phone: 256-655-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: