Provider Demographics
NPI:1407141120
Name:QUALLS, JAMES R (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:QUALLS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MEDICAL CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9124
Mailing Address - Country:US
Mailing Address - Phone:903-675-5744
Mailing Address - Fax:903-675-5677
Practice Address - Street 1:1505 STATE HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-8950
Practice Address - Country:US
Practice Address - Phone:903-675-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0656207Q00000X
TXBP10038570207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1L8412OtherMEDICARE
TXP02604877OtherRR MCR
TX324380002Medicaid