MEDICARE: DR. DONNA ANNE CORRE-SULLIVAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIR001496	GA

General Provider Information

NPI Number	:	1275683153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA ANNE CORRE-SULLIVAN D.C.

Provider Business Mailing Address
First Line	:	326 STARBRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-2817
Country	:	US
Telephone Number	:	706-864-0882
Fax Number	:	706-867-7969

Provider Business Practice Location Address
First Line	:	326 STARBRIDGE RD
Second Line	:
City	:	MURRAYVILLE
State	:	GA
Zip	:	30564-2817
Country	:	US
Telephone Number	:	706-864-0882
Fax Number	:	706-867-7969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/08/2013

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