MEDICARE: STEPHEN GERARD QUILL MD

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	208600000X	Surgery Physician	035321	GA

General Provider Information

NPI Number	:	1265439020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GERARD QUILL MD

Provider Business Mailing Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 300
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	770-338-8362
Fax Number	:	770-338-8364

Provider Business Practice Location Address
First Line	:	771 OLD NORCROSS RD
Second Line	:	SUITE 300
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4386
Country	:	US
Telephone Number	:	770-338-8362
Fax Number	:	770-338-8364

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/12/2016

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