Healthcare Provider Details

I. General information

NPI: 1710965306
Provider Name (Legal Business Name): JENNIFER QUILLIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13596 HWY 231 431 N SUITE 2
HAZEL GREEN AL
35750-8642
US

IV. Provider business mailing address

13596 HWY 231 431 N SUITE 2
HAZEL GREEN AL
35750-8642
US

V. Phone/Fax

Practice location:
  • Phone: 256-828-2094
  • Fax: 256-828-0526
Mailing address:
  • Phone: 256-828-2094
  • Fax: 256-828-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25223
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: