Sullivan, Kevin L.

Sullivan, Kevin L. is an individual health care provider with primary practice located at 250 Ponce De Leon Ave Suite 100, Decatur GA 30030-3406. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology is his primary health care specialty. Sullivan, Kevin L. can be contacted via phone (404) 377-9171.

Contact Information

Primary practice address
250 Ponce De Leon Ave Suite 100 Decatur GA 30030-3406
Phone: (404) 377-9171
Fax: (404) 377-9172
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X MD027085E Pennsylvania
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X MD027085E Pennsylvania
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 053430 Georgia

Profile Details

NPI number 1447276225
LBN Legal business name Sullivan, Kevin L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2006
Last updated Jul 27th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447276225 NPPES
Georgia MEDICAID 409020411I

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