MEDICARE: MS. AMY QUADRENA HARRIEL CSFA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant
2	246ZC0007X	Surgical Assistant	207688	GA

General Provider Information

NPI Number	:	1154034452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY QUADRENA HARRIEL CSFA

Provider Business Mailing Address
First Line	:	11565 CREEKSTONE RD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3467
Country	:	US
Telephone Number	:	404-380-0360
Fax Number	:

Provider Business Practice Location Address
First Line	:	11565 CREEKSTONE RD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-3467
Country	:	US
Telephone Number	:	404-380-0360
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/08/2026

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