Provider Demographics
NPI:1194749408
Name:SULLIVAN, JAN GREER (MD, MSPH)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:GREER
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:MD, MSPH
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2200 FORT ROOTS DR BLDG 58
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-1713
Mailing Address - Fax:501-257-1718
Practice Address - Street 1:2200 FORT ROOTS DR BLDG 58
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1713
Practice Address - Fax:501-257-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1587283Q00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry