=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669598132
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH MCGRAW QUINTON L.C.S.W.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 463 ERNEST BILES DR SUITE B
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30233-2229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-775-6645
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 S GREEN ST
-----------------------------------------------------
City | THOMASTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30286-4617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-648-2054
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW002588
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------