Beth Ann Sullivan, DO
Individual provider Active NPI Family Medicine Physician · Lawrenceville, GA
NPI 1669476388 · NPPES record last updated Mar 5, 2014
Key facts
- NPI
- 1669476388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 049106 (GA)
- Practice address
- 1960 Riverside Pkwy
Ste 106
Lawrenceville, GA 30043-5945 - Phone
- (678) 407-2222
- NPI assigned
- Jun 9, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| BJC Medical Emergency Physicians, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 049106 | GA | Yes |
Addresses
Primary practice location
1960 Riverside Pkwy
Ste 106
Lawrenceville, GA 30043-5945
Mailing address
1960 Riverside Pkwy
Ste 106
Lawrenceville, GA 30043-5945
Phone (678) 407-2222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7393382 | Other | GA | AETNA PROVIDER ID |
| 10041812 | Medicaid | GA | |
| 54305 | Other | GA | SOUTHCARE ID |
| 000888698D | Medicaid | GA | |
| 327120 | Medicaid | GA | |
| 85002412G | Medicaid | GA | |
| 903825 | Other | GA | BCBSGA PROVIDER ID |
Other names
- Dr. Beth Ann Cornish
Other providers in Lawrenceville, GA
- Sugarloaf Pkwy Pharmacy Inc.
- Sugarloaf Spine & Rehab Inc
- Sugarloaf Vision Center LLC
- Neeta Dattoba Sukthanker
- Alana Corwin Sulka
- Eva Lukkonen Sullivan
- Shafqat Sultana
- Meghan Lynn Summerall
- Quinnay Summers
- Summit Clinical Labortary Inc
All providers in Lawrenceville, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.