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General NPI Number Information
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NPI Number | 1083714042
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Entity Type | Organization
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Legal Business Name | JAMES S SULLIVAN M.D. PA
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/25/2007
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Provider Practice Location Address
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Address Line | 4300 MAIN ST W SUITE 16
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City | DOTHAN
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State | AL
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Zip | 36301-1098
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Country | US
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Telephone | 334-793-1038
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Fax | 334-615-8444
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Provider Business Mailing Address
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Address Line | 4300 MAIN ST W SUITE 16
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City | DOTHAN
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State | AL
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Zip | 36301-1098
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Country | US
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Telephone | 334-793-1038
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Fax | 334-615-8444
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES S SULLIVAN
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Credential | M.D.
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Telephone | 334-793-1038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5184
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License Number State | AL
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