Healthcare Provider Details

I. General information

NPI: 1619124310
Provider Name (Legal Business Name): QUINISHA KAYON LOGAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3714 HIGHWAY 72 W
CORINTH MS
38834-8556
US

IV. Provider business mailing address

3714 HIGHWAY 72 W
CORINTH MS
38834-8556
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-6913
  • Fax:
Mailing address:
  • Phone: 662-287-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number21498
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: