Provider Demographics
NPI:1841689734
Name:QUINTON, JODIE (PA-AA)
Entity type:Individual
Prefix:MR
First Name:JODIE
Middle Name:
Last Name:QUINTON
Suffix:
Gender:M
Credentials:PA-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 MEADOW LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4620
Mailing Address - Country:US
Mailing Address - Phone:770-402-2661
Mailing Address - Fax:
Practice Address - Street 1:1230 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3791
Practice Address - Country:US
Practice Address - Phone:706-389-2125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10815367H00000X
GARN213998163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine