Provider Demographics
NPI:1851019335
Name:O'QUINN, MADISON ROSE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:ROSE
Last Name:O'QUINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3235
Mailing Address - Country:US
Mailing Address - Phone:912-432-7938
Mailing Address - Fax:
Practice Address - Street 1:122 W COURT ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3235
Practice Address - Country:US
Practice Address - Phone:912-432-7938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician