Healthcare Provider Details

I. General information

NPI: 1952795403
Provider Name (Legal Business Name): RAE ROCHEL QUIGLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

525 VERDAE BLVD STE 200
GREENVILLE SC
29607-4021
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-8489
  • Fax: 601-984-2086
Mailing address:
  • Phone: 864-272-0388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number92544
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: