Provider Demographics
NPI:1306993886
Name:QUINN, MICHAEL W (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3614 J. DEWEY GRAY CIRCLE
Mailing Address - Street 2:BLDG B.
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-504-4651
Mailing Address - Fax:706-504-4639
Practice Address - Street 1:3614 J. DEWEY GRAY CIRCLE
Practice Address - Street 2:BLDG B.
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-504-4651
Practice Address - Fax:706-504-4639
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE20750207RS0012X
GA061325207RP1001X, 207RS0012X, 207RC0200X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003123489FMedicaid