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General NPI Number Information
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NPI Number | 1043303548
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Entity Type | Individual
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Provider Name | JOSEPH C SULLIVAN III M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/29/2023
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Provider Practice Location Address
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Address Line | 11375 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5409
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Country | US
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Telephone | 904-236-5884
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Fax | 904-346-4334
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Provider Business Mailing Address
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Address Line | PO BOX 116700
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City | ATLANTA
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State | GA
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Zip | 30368-6700
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Country | US
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Telephone | 904-236-5884
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Fax | 904-346-4334
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 052837
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 54994
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 24871
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME160669
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License Number State | FL
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