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

Mallory Breanna Sullivan

Individual provider Acute Care Nurse Practitioner · NPI 1124663331

Mallory Breanna Sullivan is a Nurse Practitioner in Atlanta, Georgia. Qualified in 2022, 4 years ago. Practices with Grady Memorial Hospital Corporation, a 363-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
4
Licensed in
GA
In the registry since
2019
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Practice location Address checks out

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3050
Phone: (404) 616-1000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence RN289418 (GA)

Record details

NPI number1124663331
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 12, 2019
Last updated in NPPESNovember 11, 2022
Certification dateNovember 11, 2022

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Grady Memorial Hospital Corporation — 363 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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