Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 38819 | TN |
NPI | 1417085606 |
---|---|
Provider Name | Ryan Richard Sullivan |
First Address | Columbia, TN 38401-4828 |
Second Address | Spring Hill, TN 37174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 21/11/2018 |