Healthcare Provider Details

I. General information

NPI: 1508814484
Provider Name (Legal Business Name): DONALD J SULLIVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9639 FOX HILL CIR N
GERMANTOWN TN
38139-6812
US

IV. Provider business mailing address

PO BOX 1000 DEPT 0194
MEMPHIS TN
38148-2246
US

V. Phone/Fax

Practice location:
  • Phone: 901-315-7932
  • Fax:
Mailing address:
  • Phone: 901-315-7932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number26078
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number26078
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: