Provider Demographics
NPI:1881640514
Name:QUARLES, GLENN R (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:QUARLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1271 MORNING DOVE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2821
Mailing Address - Country:US
Mailing Address - Phone:423-239-0227
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:726 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3989
Practice Address - Country:US
Practice Address - Phone:423-522-6560
Practice Address - Fax:423-587-4552
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28374207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1881640514Medicaid
VAVV0244AMedicare PIN
B92173Medicare UPIN
TN103I936092Medicare PIN