Provider Demographics
NPI:1093817157
Name:QUILLIAN, CATHLEEN WOOD (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:WOOD
Last Name:QUILLIAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 COLLIERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:706-769-4141
Mailing Address - Fax:912-350-8067
Practice Address - Street 1:1107 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-5701
Practice Address - Country:US
Practice Address - Phone:912-350-8404
Practice Address - Fax:912-350-8067
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000904615AOtherMEDICAID ID FROM OLD GROUP
GA08BBVCPOtherMEDICARE PTAN FROM OLD GROUP
SCGA1017Medicaid
GAP00778527OtherRR MEDICARE
GA296899578BMedicaid
SCGA1017Medicaid
GA08BBVCPOtherMEDICARE PTAN FROM OLD GROUP