Provider Demographics
NPI:1366459026
Name:QUINN, CHEMENE (MD)
Entity Type:Individual
Prefix:
First Name:CHEMENE
Middle Name:
Last Name:QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3135
Mailing Address - Street 2:DERMATOLOGY CONSULTANTS, PLLC
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-3135
Mailing Address - Country:US
Mailing Address - Phone:601-968-1912
Mailing Address - Fax:
Practice Address - Street 1:501 MARSHALL ST STE 406
Practice Address - Street 2:DERMATOLOGY CONSULTANTS, PLLC
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1650
Practice Address - Country:US
Practice Address - Phone:601-968-1912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63958207N00000X
MS18070207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00121904OtherMEDICARE RAILROAD
MS0282520Medicaid
H79272Medicare UPIN
MSP00121904OtherMEDICARE RAILROAD