Provider Demographics
NPI:1770596181
Name:QUATTLEBAUM, JULIE MILLER (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MILLER
Last Name:QUATTLEBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MILLER
Other - Last Name:DENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:215 TOWN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 TOWN CREEK RD
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5843
Practice Address - Country:US
Practice Address - Phone:803-508-7651
Practice Address - Fax:803-508-7655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA752529620AMedicaid
GA93BBKBPMedicare PIN