Dr Andre Jawann Sullivan, MD | |
325 Mdg, 340 Magnolia Circle, Tyndall Afb, FL 32403 | |
(703) 731-2566 | |
Not Available |
Full Name | Dr Andre Jawann Sullivan |
---|---|
Gender | Male |
Speciality | Psychiatry & Neurology - Psychiatry |
Location | 325 Mdg, 340 Magnolia Circle, Tyndall Afb, Florida |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1023162559 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 41880 (Tennessee) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | R9446 (Texas) | Primary |
Entity Name | Austin Travis County Mental Health And Mental Retardation Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1750337259 PECOS PAC ID: 9133016306 Enrollment ID: O20040305000036 |
Entity Name | Permian Basin Community Centers For Mental Health & Mental Retardation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1700976453 PECOS PAC ID: 8426955865 Enrollment ID: O20040427000950 |
Entity Name | Burke Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1396792420 PECOS PAC ID: 1254312077 Enrollment ID: O20040527000661 |
Entity Name | Camino Real Community Mhmr Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1154411262 PECOS PAC ID: 9931183449 Enrollment ID: O20040614001095 |
Entity Name | Heart Of Texas Region Mhmr Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1639399132 PECOS PAC ID: 9830105105 Enrollment ID: O20060223000214 |
Mailing Address | Practice Location Address |
---|---|
Dr Andre Jawann Sullivan, MD 325 Mdg, 340 Magnolia Circle, Tyndall Afb, FL 32403 Ph: (703) 731-2566 | Dr Andre Jawann Sullivan, MD 325 Mdg, 340 Magnolia Circle, Tyndall Afb, FL 32403 Ph: (703) 731-2566 |