Provider Demographics
NPI:1154536613
Name:SULLENS, PATRICIA A (MEDICAL ASSIT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SULLENS
Suffix:
Gender:F
Credentials:MEDICAL ASSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PROFESSIONAL COMPLEX
Mailing Address - Street 2:SUITE 479D
Mailing Address - City:BALDWIN
Mailing Address - State:GA
Mailing Address - Zip Code:30511
Mailing Address - Country:US
Mailing Address - Phone:706-778-0033
Mailing Address - Fax:
Practice Address - Street 1:441 PROFESSIONAL COMPLEX
Practice Address - Street 2:SUITE 479D
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511
Practice Address - Country:US
Practice Address - Phone:706-778-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education