Provider Demographics
NPI:1740443118
Name:SULLIVAN, ALICE PRESCOTT (DO)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:PRESCOTT
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:BENJAMIN
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3201 DOWNWOOD CIR NW UNIT 1409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1722
Mailing Address - Country:US
Mailing Address - Phone:512-777-9804
Mailing Address - Fax:855-488-4577
Practice Address - Street 1:3193 HOWELL MILL RD NW STE 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2100
Practice Address - Country:US
Practice Address - Phone:707-308-8675
Practice Address - Fax:855-488-4577
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013517207Q00000X
GA98423207Q00000X
TXN0379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine