Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jerry Sullivan, PA

Individual provider Medical Physician Assistant · NPI 1629062724

Jerry Sullivan, PA is a Physician Assistant in Tifton, Georgia. Qualified in 2004, 22 years ago. Practices with Tift Regional Health System Inc, a 292-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
22
Licensed in
GA
In the registry since
2005
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

2225 US Highway 41 N
Tifton, GA 31794-2749
Phone: (229) 391-4100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 004285 (GA)

Record details

NPI number1629062724
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 2, 2005
Last updated in NPPESApril 6, 2021
Certification dateApril 6, 2021
Mailing address907 18th St E Ste 400, Tifton, GA 31794-3684

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Tift Regional Health System Inc — 292 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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