Healthcare Provider Details

I. General information

NPI: 1255868196
Provider Name (Legal Business Name): ROBERT E QUICK III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FALLS RD
TOCCOA GA
30577-1631
US

IV. Provider business mailing address

163 HOSPITAL DR
TOCCOA GA
30577-6820
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-5840
  • Fax: 706-898-5344
Mailing address:
  • Phone: 706-282-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86418
License Number StateGA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: