Provider Demographics
NPI:1518905470
Name:QUINN, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:QUINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1161
Mailing Address - Country:US
Mailing Address - Phone:770-793-7500
Mailing Address - Fax:770-793-7985
Practice Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Practice Address - Street 2:SUITE LL1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1161
Practice Address - Country:US
Practice Address - Phone:770-793-7500
Practice Address - Fax:770-793-7985
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0503162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911325GMedicaid
GA656499202BMedicaid
GA656499202CMedicaid
GA92BBGBTOtherMEDICARE PROVIDER ID
GA656499202DMedicaid
GA000911325JMedicaid
GA656499202EMedicaid
GA656499202FMedicaid
GA656499202AMedicaid
GAG29917Medicare UPIN