Healthcare Provider Details

I. General information

NPI: 1235182726
Provider Name (Legal Business Name): GEORGE ALBERT QUARTUCCIO H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 OLD TROLLEY RD SUITE C
SUMMERVILLE SC
29485-8224
US

IV. Provider business mailing address

125 CANDACE DR
RIDGEVILLE SC
29472-8802
US

V. Phone/Fax

Practice location:
  • Phone: 843-821-4327
  • Fax:
Mailing address:
  • Phone: 843-817-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAS-442
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: