Provider Demographics
NPI:1710506100
Name:SULLIVAN, GINA M (CMA CPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:CMA CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 COUNTY ROAD 2629
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-7476
Mailing Address - Country:US
Mailing Address - Phone:903-259-0550
Mailing Address - Fax:903-328-6568
Practice Address - Street 1:4235 COUNTY ROAD 2629
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-7476
Practice Address - Country:US
Practice Address - Phone:903-259-0550
Practice Address - Fax:903-328-6568
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based