Sullivan, Beth Ann

Sullivan, Beth Ann is an individual health care provider with primary practice located at 1960 Riverside Pkwy Ste 106, Lawrenceville GA 30043-5945. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Sullivan, Beth Ann can be contacted via phone (678) 407-2222.

Contact Information

Primary practice address
1960 Riverside Pkwy Ste 106 Lawrenceville GA 30043-5945
Phone: (678) 407-2222
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 049106 Georgia

Profile Details

NPI number 1669476388
LBN Legal business name Sullivan, Beth Ann
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2005
Last updated Mar 5th, 2014 - 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 1669476388 NPPES
Georgia Other 7393382 AETNA PROVIDER ID
Georgia MEDICAID 10041812 AETNA PROVIDER ID
Georgia Other 54305 AETNA PROVIDER ID
Georgia MEDICAID 000888698D AETNA PROVIDER ID
Georgia MEDICAID 327120 AETNA PROVIDER ID
Georgia MEDICAID 85002412G AETNA PROVIDER ID
Georgia Other 903825 AETNA PROVIDER ID

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