Healthcare Provider Details

I. General information

NPI: 1770596181
Provider Name (Legal Business Name): JULIE MILLER QUATTLEBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE MILLER DENNARD MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 UNIVERSITY PKWY
EVANS GA
30809-3058
US

IV. Provider business mailing address

215 TOWN CREEK RD
AIKEN SC
29803-5843
US

V. Phone/Fax

Practice location:
  • Phone: 706-790-4440
  • Fax: 706-737-3321
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number56278
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24025
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier752529620A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: