Provider Demographics
NPI:1790852465
Name:SULLIVAN, DAVIS LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:LEE
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 ALISON DR STE 8
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4411
Mailing Address - Country:US
Mailing Address - Phone:256-234-3477
Mailing Address - Fax:
Practice Address - Street 1:59 ALISON DR STE 8
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4411
Practice Address - Country:US
Practice Address - Phone:256-234-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51045658OtherBCBS
AL529403570Medicaid
AL000045658Medicaid
AL000045658Medicaid