Provider Demographics
NPI:1740723147
Name:SULLEN, FRANK JAMES JR
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:JAMES
Last Name:SULLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532926
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-2926
Mailing Address - Country:US
Mailing Address - Phone:334-430-3100
Mailing Address - Fax:334-593-6609
Practice Address - Street 1:500 NORTHRIDGE RD
Practice Address - Street 2:SUITE 330
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-3315
Practice Address - Country:US
Practice Address - Phone:404-941-1291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-122658367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered