Most Relevant Information
Provider Data
| NPI Number: | 1003804352 |
| Provider Name: | MANLY JACKSON SULLIVAN MEDICAL DOCTOR |
| Entity Type: | Individual |
| Taxonomy Code: | 207P00000X |
| Specialty: | Emergency Medicine |
| License Number: | 20081 |
Most Important Dates
| Enumeration Date: | 10/11/2005 |
| Last Updated: | 07/09/2007 |
Provider Practice Location
241 ROBERT K WILSON DR
CARROLLTON
AL
354478010
Practice Location Phone/Fax
| Phone: | 2053672408 |
| Fax: | 2053679123 |
Provider Mailing Location
241 ROBERT K WILSON DR
CARROLLTON
AL
354478010
Provider Mailing Phone/Fax
| Phone: | 2053672408 |
| Fax: | 2053679123 |