Provider Demographics
NPI:1992563324
Name:MANSELL, QUINCY
Entity type:Individual
Prefix:
First Name:QUINCY
Middle Name:
Last Name:MANSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 REBECCA ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2046
Mailing Address - Country:US
Mailing Address - Phone:864-451-1837
Mailing Address - Fax:
Practice Address - Street 1:1115 TANNER RD UNIT 200
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-1701
Practice Address - Country:US
Practice Address - Phone:864-451-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care