1518905470 NPI number — MARK S QUINN MD

Table of content: MARK S QUINN MD (NPI 1518905470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518905470 NPI number — MARK S QUINN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUINN
Provider First Name:
MARK
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518905470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 KENNESTONE HOSPITAL BLVD
Provider Second Line Business Mailing Address:
SUITE LL1
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-1161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-793-7500
Provider Business Mailing Address Fax Number:
770-793-7985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 KENNESTONE HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
SUITE LL1
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-793-7500
Provider Business Practice Location Address Fax Number:
770-793-7985
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  050316 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000911325G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656499202B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656499202C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92BBGBT . This is a "MEDICARE PROVIDER ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 656499202D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000911325J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656499202E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656499202F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656499202A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com