Provider Demographics
NPI:1437479219
Name:FARMER, QUENTIN BOYLES III
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:BOYLES
Last Name:FARMER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1549
Mailing Address - Country:US
Mailing Address - Phone:404-575-4500
Mailing Address - Fax:404-575-4555
Practice Address - Street 1:6335 HOSPITAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-575-4500
Practice Address - Fax:404-575-4555
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASTUDENT363A00000X
GA005857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA714120953LMedicaid
GA10297I9672Medicare PIN