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NPI Code Detail

MEDICARE: MR. CLIFTON LEE QUINN JR. PA-C

MEDICARE: MR. CLIFTON LEE QUINN JR. PA-C
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
1363AM0700XMedical Physician Assistant103099NC

General Provider Information

NPI Number : 1700863073
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLIFTON LEE QUINN JR. PA-C
Provider Business Mailing Address
First Line : PO BOX 3586
Second Line :
City : GREENVILLE
State : NC
Zip : 27836-1586
Country : US
Telephone Number : 252-758-4455
Fax Number : 252-758-6742
Provider Business Practice Location Address
First Line : 3121 MOSELEY DR
Second Line :
City : GREENVILLE
State : NC
Zip : 27858-4245
Country : US
Telephone Number : 252-758-4455
Fax Number : 252-758-6742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 09/10/2008

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