Provider Demographics
NPI:1255770210
Name:BURKETT, RACHELANN SULLIVAN (MD)
Entity type:Individual
Prefix:
First Name:RACHELANN
Middle Name:SULLIVAN
Last Name:BURKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHELANN
Other - Middle Name:COOLEY
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4700 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-273-9700
Mailing Address - Fax:334-273-9788
Practice Address - Street 1:4700 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-273-9700
Practice Address - Fax:334-273-9788
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-22
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42968208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics