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DR. MANLY JACKSON SULLIVAN MEDICAL DOCTOR

>> Emergency Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1003804352

Individual Registrant:
DR. MANLY JACKSON SULLIVAN MEDICAL DOCTOR
Gender: M

Location and contact information for practice:
241 ROBERT K WILSON DR  CARROLLTON, AL 35447-8010 US
Tel: 205-367-2408  Fax: 205-367-9123

Contact information for business:
241 ROBERT K WILSON DR  CARROLLTON, AL 35447-8010 US
Tel: 205-367-2408  Fax: 205-367-9123

Registration Information:
NPI: 1003804352
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207P00000XAllopathic & Osteopathic Physicians
Emergency Medicine
AL20081

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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