MEDICARE: DR. JENNIFER QUILLIN M.D.

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	2080A0000X	Pediatric Adolescent Medicine Physician	25223	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51516137	OTHER		BCBS

General Provider Information

NPI Number	:	1710965306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER QUILLIN M.D.

Provider Business Mailing Address
First Line	:	13596 HWY 231 431 N
Second Line	:	SUITE 2
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8642
Country	:	US
Telephone Number	:	256-828-2094
Fax Number	:	256-828-0526

Provider Business Practice Location Address
First Line	:	13596 HWY 231 431 N
Second Line	:	SUITE 2
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8642
Country	:	US
Telephone Number	:	256-828-2094
Fax Number	:	256-828-0526

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	05/19/2023

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