Manly Jackson Sullivan, MEDICAL DOCTOR
Individual provider Active NPI Emergency Medicine Physician · Carrollton, AL
NPI 1003804352 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1003804352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 20081 (AL)
- Practice address
- 241 Robert K Wilson Dr
Carrollton, AL 35447-8010 - Phone
- (205) 367-2408
- Fax
- (205) 367-9123
- NPI assigned
- Oct 11, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- University of Alabama School of Medicine, 1995
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- NWMC Emergency Physicians LLC
Relias Emergency Medicine Specialists of Fayette LLC
Sycamore Lakeland LLC
Practice addresses (Care Compare)
1530 US Hwy 43
Winfield, AL 35594-5056
Phone (205) 487-7773
1653 Temple Ave N
Fayette, AL 35555-1314
Phone (205) 932-5966
42024 Hwy 195
Haleyville, AL 35565-7054
Phone (205) 486-5213
Hospital & facility affiliations
- Fayette Medical Center
- North Mississippi Health Services - South Marion
- DCH Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101228000532 | AL | Practitioner - Emergency Medicine |
8224226709 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NWMC Emergency Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
| Pickens County Medical Center Inc | Current | Accepting new patients | |
| Sycamore Lakeland LLC | Emergency Medicine | Current |
Accepting new patients |
| Relias Emergency Medicine Specialists of Fayette, LLC | Emergency Medicine | Current |
Accepting new patients |
| Pickens County Health Care Authority | Current | Accepting new patients | |
| Lakeland Physicians LLC | Emergency Medicine | Current |
Accepting new patients |
| Lakeland Physician Practices LLC | Past |
Accepting new patients |
Locations
241 Robert K Wilson Dr
Carrollton, AL 35447
Phone (205) 367-2408
1653 Temple Ave N
Fayette, AL 35555
Phone (205) 759-7063
42024 Highway 195
Haleyville, AL 35565
Phone (205) 485-7371
22014 Highway 5
Lynn, AL 35575
Phone (205) 485-7113
1530 US Highway 43
Winfield, AL 35594
Phone (205) 487-7000
Interoperability endpoints
- https://fhir.yourcareuniverse.net/tenant/98653bdc-9a2b-4fae-a56c-78b209247c4f
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 20081 | AL | Yes |
Addresses
Primary practice location
241 Robert K Wilson Dr
Carrollton, AL 35447-8010
Mailing address
241 Robert K Wilson Dr
Carrollton, AL 35447-8010
Phone (205) 367-2408
Other providers in Carrollton, AL
- Isabel Sanders
- Kymberlee Sherrell
- Chelsie Noland Skinner
- State of Alabama
- State of Alabama Department of Public Health
- Sallie Turner
- Amber Turnipseed
- Whatley Health Services, Inc.
- Tyronda Wheaton
- York Drug, Inc
All providers in Carrollton, AL · Emergency Medicine Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.