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General NPI Number Information
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NPI Number | 1154653590
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Entity Type | Organization
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Legal Business Name | DR. STEPHEN QUILL, MD, PC
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD SUITE 300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 770-338-8362
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Fax | 770-338-8364
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Provider Business Mailing Address
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Address Line | 771 OLD NORCROSS RD SUITE 300
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4386
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Country | US
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Telephone | 770-338-8362
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Fax | 770-338-8364
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Authorized Official
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Title or Position | MD
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Name | DR. STEPHEN G QUILL
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Credential | M.D.
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Telephone | 770-338-8362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 035321
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License Number State | GA
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