Provider Demographics
NPI:1477120095
Name:QUICK, KATHLEEN (MS MBM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:QUICK
Suffix:
Gender:F
Credentials:MS MBM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 BULL ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9181
Mailing Address - Country:US
Mailing Address - Phone:804-869-3508
Mailing Address - Fax:
Practice Address - Street 1:5350 BULL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9181
Practice Address - Country:US
Practice Address - Phone:804-869-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherTRICARE