Provider Demographics
NPI:1477540441
Name:QUISLING, SCOTT G (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:G
Last Name:QUISLING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:758 OLD NORCROSS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3385
Mailing Address - Country:US
Mailing Address - Phone:770-962-4300
Mailing Address - Fax:770-339-7544
Practice Address - Street 1:758 OLD NORCROSS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3385
Practice Address - Country:US
Practice Address - Phone:770-962-4300
Practice Address - Fax:770-339-7544
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2009-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA040765207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000850374CMedicaid
GAH02832Medicare UPIN
GA20BBDWQMedicare PIN