Provider Demographics
NPI:1295267375
Name:QUIYIM, IFRAJ (EDS)
Entity type:Individual
Prefix:
First Name:IFRAJ
Middle Name:
Last Name:QUIYIM
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31415-5284
Mailing Address - Country:US
Mailing Address - Phone:404-334-0443
Mailing Address - Fax:
Practice Address - Street 1:1015 PORTER ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31415-5284
Practice Address - Country:US
Practice Address - Phone:404-334-0443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA245433103TS0200X
FL1046423103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool