Provider Demographics
NPI:1700863073
Name:QUINN, CLIFTON LEE JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:LEE
Last Name:QUINN
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3586
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27836-1586
Mailing Address - Country:US
Mailing Address - Phone:252-758-4455
Mailing Address - Fax:252-758-6742
Practice Address - Street 1:3121 MOSELEY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4245
Practice Address - Country:US
Practice Address - Phone:252-758-4455
Practice Address - Fax:252-758-6742
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2761578Medicare ID - Type Unspecified
NCQ25040Medicare UPIN