Healthcare Provider Details

I. General information

NPI: 1417085606
Provider Name (Legal Business Name): RYAN RICHARD SULLIVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MILL POND RD STE 200
MOUNT PLEASANT TN
38474-1034
US

IV. Provider business mailing address

1012 MILL POND RD
MOUNT PLEASANT TN
38474-1034
US

V. Phone/Fax

Practice location:
  • Phone: 615-585-5546
  • Fax:
Mailing address:
  • Phone: 615-585-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number38819
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberS8124
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: