Provider Demographics
NPI:1366543522
Name:SULLIVAN-FORD, RHONDA KAYE (MD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:KAYE
Last Name:SULLIVAN-FORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 LAKELAND DR STE 600
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7640
Mailing Address - Country:US
Mailing Address - Phone:601-939-1600
Mailing Address - Fax:601-939-1606
Practice Address - Street 1:2506 LAKELAND DR STE 600
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7640
Practice Address - Country:US
Practice Address - Phone:601-939-1600
Practice Address - Fax:601-939-1606
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS14822OtherMISSISSIPPI LICENSE
TN24904OtherTENNESSEE LICENSE
MS0116938Medicaid
MS14822OtherMISSISSIPPI LICENSE
TN24904OtherTENNESSEE LICENSE