Provider Demographics
NPI:1891827390
Name:FAQUIN, CQRNELL CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CQRNELL
Middle Name:CHARLES
Last Name:FAQUIN
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 1:2749 HUNTERS DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-6224
Mailing Address - Country:US
Mailing Address - Phone:901-755-4387
Mailing Address - Fax:901-755-0718
Practice Address - Street 1:2749 HUNTERS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-6224
Practice Address - Country:US
Practice Address - Phone:901-755-4387
Practice Address - Fax:901-755-0718
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD3354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD3354OtherSTATE LICENSE