Beth Ann Sullivan, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

049106 Issued in GA

Practice address

1960 Riverside Pkwy
Ste 106
Lawrenceville, GA 30043-5945

Phone

(678) 407-2222

NPI assigned

Jun 9, 2005

Last updated

Mar 5, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Beth Ann Cornish Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• BJC Medical Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Commerce, GA
  • NPI 1104843895
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1669476388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1960 RIVERSIDE PKWY",
            "address_2": "STE 106",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435945",
            "telephone_number": "678-407-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1960 RIVERSIDE PKWY",
            "address_2": "STE 106",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435945",
            "telephone_number": "678-407-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BETH",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "049106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETH",
            "last_name": "CORNISH",
            "middle_name": "ANN",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sugarloaf Pkwy Pharmacy Inc. (Sugarloaf Parkway Pharmacy Inc.)
• Sugarloaf Spine & Rehab Inc
• Sugarloaf Vision Center LLC
• Neeta Dattoba Sukthanker, MD
• Alana Corwin Sulka, MPH,RN,CPH,CIC
• Eva Lukkonen Sullivan, MM MA CCC-SLP
• Shafqat Sultana, FNP
• Meghan Lynn Summerall, P.A.
• Quinnay Summers, RBT
• Summit Clinical Labortary Inc

• Family Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.