Provider Demographics
NPI:1982639902
Name:QUARLES, JAMES DOUGLAS JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:QUARLES
Suffix:JR
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 1:4350 TOWNE CENTRE DR STE 2200
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3301
Mailing Address - Country:US
Mailing Address - Phone:706-722-0705
Mailing Address - Fax:762-333-0496
Practice Address - Street 1:4350 TOWNE CENTRE DR STE 2200
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3301
Practice Address - Country:US
Practice Address - Phone:706-722-0705
Practice Address - Fax:762-333-0496
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032460208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00416292DMedicaid
GA00416292DMedicaid
F15921Medicare UPIN