1588613020 NPI number — DR. JAMES GREGORY SULLIVAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588613020 NPI number — DR. JAMES GREGORY SULLIVAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
JAMES
Provider Middle Name:
GREGORY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SULLIVAN
Provider Other First Name:
JAMES
Provider Other Middle Name:
GREGORY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1588613020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1160 HUFFMAN RD
Provider Second Line Business Mailing Address:
PARKWAY MEDICAL CENTER
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-815-5000
Provider Business Mailing Address Fax Number:
205-815-5246

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 HUFFMAN RD
Provider Second Line Business Practice Location Address:
PARKWAY MEDICAL CENTER
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35215-7502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-815-5000
Provider Business Practice Location Address Fax Number:
205-815-5246
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  AL11351 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 528700720 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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