Provider Demographics
NPI:1093008476
Name:SULLENGER, JAMES LAWSON
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LAWSON
Last Name:SULLENGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 NORTH LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464
Mailing Address - Country:US
Mailing Address - Phone:931-762-8996
Mailing Address - Fax:931-762-7576
Practice Address - Street 1:2201 NORTH LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-8996
Practice Address - Fax:931-762-7576
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC6779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist