Provider Demographics
NPI:1194160044
Name:SULLIVAN, STEPHANIE TIV (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TIV
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3850 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4807
Mailing Address - Country:US
Mailing Address - Phone:404-452-1684
Mailing Address - Fax:770-418-9530
Practice Address - Street 1:3020 HIGHWAY 124
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4614
Practice Address - Country:US
Practice Address - Phone:770-978-1331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2023-02-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant