| Doctor Name: | PATRICIA A SULLENS |
| NPI Number: | 1154536613 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MEDICAL ASSIT |
| License Number: | |
| Business Practice Address: | 441 Professional Complex Suite 479d Baldwin, GA - 30511 |
| Business Phone Number: | 7067780033 |
| Business Fax Number: | |
| Mailing Address: | 441 Professional Complex, Suite 479d BALDWIN |
| State: | GA |
| Postal Code: | 30511 |
| Phone Number: | 7067780033 |
| Fax Number: | |
| NPI Enumeration Date: | 05/10/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |