Provider Demographics
NPI:1588613020
Name:SULLIVAN, JAMES GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GREGORY
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:GREGORY
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1160 HUFFMAN RD
Mailing Address - Street 2:PARKWAY MEDICAL CENTER
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215
Mailing Address - Country:US
Mailing Address - Phone:205-815-5000
Mailing Address - Fax:205-815-5246
Practice Address - Street 1:1160 HUFFMAN RD
Practice Address - Street 2:PARKWAY MEDICAL CENTER
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-7502
Practice Address - Country:US
Practice Address - Phone:205-815-5000
Practice Address - Fax:205-815-5246
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL11351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL528700720Medicaid
AL528700720Medicaid
AL000016899Medicare ID - Type Unspecified