Healthcare Provider Details

I. General information

NPI: 1336133461
Provider Name (Legal Business Name): FREDERICK C QUIRK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

6046 GA HIGHWAY 116
HAMILTON GA
31811-6008
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1374
  • Fax: 706-660-2686
Mailing address:
  • Phone: 706-628-5459
  • Fax: 706-660-2686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number000650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: