Provider Demographics
NPI:1407272529
Name:SULLIVAN, RICHARD HENRY III (PA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HENRY
Last Name:SULLIVAN
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:3400 OLD MILTON PKWY STE 190
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-663-1100
Practice Address - Fax:770-663-1101
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2018-03-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant