Provider Demographics
NPI:1093933863
Name:TINNEY, QIONNA MARIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:QIONNA
Middle Name:MARIEL
Last Name:TINNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:QIONNA
Other - Middle Name:MARIEL
Other - Last Name:TINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5318 HIGHGATE DR.
Mailing Address - Street 2:SUITE 132
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6387
Mailing Address - Country:US
Mailing Address - Phone:919-342-8870
Mailing Address - Fax:
Practice Address - Street 1:5318 HIGHGATE DR.
Practice Address - Street 2:SUITE 132
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6387
Practice Address - Country:US
Practice Address - Phone:919-342-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-014002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909934Medicaid
NC5909934Medicaid