Provider Demographics
NPI:1114105335
Name:QUINN, BETHANY BIXLER (PA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:BIXLER
Last Name:QUINN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:BIXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:535 MAXHAM RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-5541
Mailing Address - Country:US
Mailing Address - Phone:770-948-6041
Mailing Address - Fax:770-948-7994
Practice Address - Street 1:3820 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1110
Practice Address - Country:US
Practice Address - Phone:770-948-6041
Practice Address - Fax:770-819-2987
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant