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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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