Thaxton Sullivan

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT9120 Issued in TX

Practice address

572 Essayons Dr.
92ND Engineer BN
Hinesville, GA 31313-3131

Phone

(601) 422-7472

NPI assigned

Sep 24, 2020

Last updated

Mar 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679443200000",
    "number": "1942817895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 COURTLAND DR APT 50",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394028186",
            "telephone_number": "601-422-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 ESSAYONS DR.",
            "address_2": "92ND ENGINEER BN",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133131",
            "telephone_number": "601-422-7472"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Courtland Dr Apt 50",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394028186",
            "country_code": "US",
            "telephone_number": "601-422-7472",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "THAXTON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-09-24",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT9120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aiyesha Quante Stiles, APRN
• Johanna Stoisavlejevic, MASSAGE THERAPIST
• Jamiya M Stokes Roberts
• Kathryn Elise Strickland, NP
• Latrice Sturghill, M.S, QBA, LBA
• Kayleen Sulton
• Luke Sunderman, DPT
• Annabeth Sutter, PHARMD
• Els J Sutton
• Christine A. Swords, FNP

• Athletic Trainer in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.