Individual provider · Type 1 NPI

Jerry Sullivan, P.A.

Medical Physician Assistant · Tifton, GA

NPI number 1629062724 Active

Practice location

2225 US Highway 41 N
Tifton, GA 31794-2749

Mailing address

907 18th St E Ste 400
Tifton, GA 31794-3684

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X004285 (GA)

Medical Physician Assistant: Definition to come...

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About NPI 1629062724

Jerry Sullivan, P.A.'s National Provider Identifier is 1629062724, issued on Sep 2, 2005. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Tifton, GA. The record was last updated on Apr 6, 2021.