JERRY SULLIVAN (NPI# 1629062724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629062724 |
| Entity Type | Individual |
| Full Name | JERRY SULLIVAN |
| Credential | P.A. |
| Practice Address |
2225 Us Highway 41 N Tifton GA 31794-2749 |
| Mailing Address |
907 18th St E Suite 150 Tifton GA 31794-3643 |
| Practice Telephone | 2293914100 |
| Mailing Telephone | 2293914100 |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2015-06-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
004285 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457409807 | Jerry Sullivan | Nurse Practitioner | 120 Market Street, Woodland, MS 39776 | 2007-01-08 |
| 1306909551 | Jerry L. Sullivan Jr. | Specialist/Technologist | 3631 S. Sixth Street, Springfield, IL 62703 | 2006-12-19 |
| 1083697742 | Jerry L Sullivan | Dentist | 1007 Reelfoot Ave, Union City, TN 38261 | 2005-11-26 |
| 1093929044 | Jerry L Sullivan | Dentist | 411 Grandview Ave, Kingman, AZ 86401-5745 | 2007-05-09 |
| 1306998406 | Jerry J. Sullivan | Family Medicine | 6501 Loisdale Ct, Springfield, VA 22150-1826 | 2007-01-17 |
| 1689697641 | Jerry Warner Sullivan | Internal Medicine | 301 N Jefferson Davis Pkwy, 1st Floor, New Orleans, LA 70119-5311 | 2006-07-25 |
| 1487631594 | Jerry Sullivan | Physical Therapist | 1975 Lin Lor Ln, Elgin, IL 60123-4902 | 2005-12-29 |
| Street Address |
2225 US HIGHWAY 41 N |
| City | TIFTON |
| State | GA |
| Zip Code | 31794-2749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154323103 | Raymond G Moreno | Internal Medicine | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2005-06-02 |
| 1063039865 | Preston Glenn Thornhill | Nurse Practitioner | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2020-06-29 |
| 1861022329 | Tift Regional Health System, Inc | Allergy & Immunology | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2020-01-23 |
| 1770113235 | Tift Regional Health System Inc. | Family Medicine | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2020-01-23 |
| 1013563733 | Emily Roxanne Hawsey | Internal Medicine | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2019-08-19 |
| 1285190918 | Radha J Patel | Nurse Practitioner | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2019-02-19 |
| 1154886745 | Emma Alsobrook | Nurse Practitioner | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2019-02-07 |
| 1174095434 | Shelley Colwell | Nurse Practitioner | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2018-12-27 |
| 1679043830 | Lindsay Peavy Drew | Nurse Practitioner | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2018-11-30 |
| 1740763911 | Casey Moran | Physical Therapist | 2225 Us Highway 41 N, Tifton, GA 31794-2749 | 2018-09-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234043 | Deloris Lunsford | Licensed Practical Nurse | 903 Washington St., Tifton, GA 31794 | 2020-01-17 |
| 1194383075 | William Jordan Kinnett | Registered Nurse | 1205 Tift Ave N, Tifton, GA 31794 | 2019-06-05 |
| 1598321200 | Courtlyn Christanna Fussell | Pharmacist | 2201 Hwy 41 N, Tifton, GA 31794 | 2019-05-17 |
| 1376027722 | Martha Gibbs | Nurse Practitioner | Affinity Clinic/west Campus, 2225 Us Hwy 41 North, Tifton, GA 31794 | 2018-09-21 |
| 1427541044 | Rebekah F Cottle | Speech-Language Pathologist | 2227 Highway 41 North, Tifton, GA 31794 | 2018-06-08 |
| 1790280857 | Tift Regional Health System Inc | Ophthalmology | 1803 Old Ocilla Road, Tifton, GA 31794 | 2018-03-29 |
| 1568975431 | Skyler Clark | Pharmacist | 2201 North 12th Street, Tifton, GA 31794 | 2017-11-14 |
| 1538606306 | Imagine Peace Counseling LLC | Counselor | 223 E 2nd Street, Suite B, Tifton, GA 31794 | 2017-01-31 |
| 1073056347 | Jessica Tumbling | Contractor | 219 Savannah Way, Tifton, GA 31794 | 2016-11-18 |
| 1992159503 | Joseph Thomas Seagraves Jr. | Nurse Practitioner | 901 East 18th Street, Tifton, GA 31794 | 2016-04-20 |
| Find all providers in zip 31794 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558739003 | Garrett Blalock | Physician Assistant | 901 18th St E, Tifton, GA 31794-3648 | 2015-09-14 |
| 1598042616 | Maureen Johnson | Physician Assistant | 1401 Tift Ave N, Suite B, Tifton, GA 31794-3585 | 2011-11-03 |
| 1508930082 | Terry Lee Morgan | Physician Assistant | 1111 20th St E, Tifton, GA 31794-3689 | 2006-11-17 |
| 1033149398 | Kimmie A Carden | Physician Assistant | 2735 Central Ave S, Tifton, GA 31794-5645 | 2006-07-03 |
| 1073576930 | Treasure F Payne | Physician Assistant | 39 Kent Rd, Suite 5, Tifton, GA 31794-1649 | 2006-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245838374 | Erica Elizabeth West | Physician Assistant | 1155 Mount Vernon Hwy Ste 101, Atlanta, GA 30338-5439 | 2020-10-12 |
| 1801402888 | Meredith Gaines | Physician Assistant | 603 W 1st St Unit 1, Rome, GA 30161-3067 | 2020-09-16 |
| 1770108805 | Kelsey Lynne Greeff | Physician Assistant | 3400 Old Milton Pkwy Ste C, Alpharetta, GA 30005-3707 | 2020-06-15 |
| 1518596733 | Rebecca Faye Tsyrlin | Physician Assistant | 2655 Dallas Hwy Sw Ste 340, Marietta, GA 30064-7518 | 2020-04-08 |
| 1487291878 | Ashley Cohen | Physician Assistant | 250 E Ponce De Leon Ave Ste 800, Decatur, GA 30030-3438 | 2019-12-04 |
| 1932757606 | Andrea J Holley | Physician Assistant | 1629 Austin Meadows Dr, Decatur, GA 30032-3888 | 2019-08-27 |
| 1265089759 | Alexis Chester Jones | Physician Assistant | 3000 Old Alabama Rd # 128, Johns Creek, GA 30022-5860 | 2019-08-20 |
| 1841851680 | Lauren Price Fogarty | Physician Assistant | 5445 Meridian Marks Rd Ste 430, Atlanta, GA 30342-4755 | 2019-06-24 |
| 1386208262 | Jessica A Drews | Physician Assistant | 2342 Cortez Way Ne, Brookhaven, GA 30319-3914 | 2019-04-26 |
| 1174187421 | Krisna Patel | Physician Assistant | 1805 Honey Creek Cmns Se Ste B, Conyers, GA 30013-5829 | 2019-04-23 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JERRY SULLIVAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.