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General NPI Number Information
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NPI Number | 1710356936
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Entity Type | Individual
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Provider Name | SOPHIA MCQUARTER
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Gender | Female
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 2706 OLD BRANDON RD
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City | PEARL
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State | MS
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Zip | 39208-4701
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Country | US
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Telephone | 601-664-0014
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Fax | 601-666-4240
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Provider Business Mailing Address
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Address Line | 863 HOLLY BUSH RD
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City | BRANDON
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State | MS
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Zip | 39047-8246
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Country | US
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Telephone | 601-829-1077
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Fax | 601-664-2405
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 253464
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License Number State | MS
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