MEDICARE: JOHN O'QUINN MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1023895299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN O'QUINN MSW

Provider Business Mailing Address
First Line	:	2140 MLK DR SW BLDG B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1134
Country	:	US
Telephone Number	:	404-609-3197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2140 MLK DR SW BLDG B
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1134
Country	:	US
Telephone Number	:	404-609-3197
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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