Provider Demographics
NPI:1790877561
Name:SULLIVAN, RODNEY ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ANTHONY
Last Name:SULLIVAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 REDBUSH CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4340
Mailing Address - Country:US
Mailing Address - Phone:423-952-0992
Mailing Address - Fax:
Practice Address - Street 1:2 REDBUSH CT
Practice Address - Street 2:SUITE 2
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4340
Practice Address - Country:US
Practice Address - Phone:423-952-0992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001569103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist