MEDICARE: SARAH RUSSELL SULLIVAN NP

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	363LF0000X	Family Nurse Practitioner	NP309323	GA

General Provider Information

NPI Number	:	1932901170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH RUSSELL SULLIVAN NP

Provider Business Mailing Address
First Line	:	1 CONCOURSE PKWY STE 620
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CONCOURSE PKWY STE 620
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5534
Country	:	US
Telephone Number	:	678-812-2212
Fax Number	:

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

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	02/18/2026

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