Provider Demographics
NPI:1982706552
Name:MCQUAIG, JAMES L JR (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MCQUAIG
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-0786
Mailing Address - Country:US
Mailing Address - Phone:912-632-7623
Mailing Address - Fax:
Practice Address - Street 1:410 E 16TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-3008
Practice Address - Country:US
Practice Address - Phone:912-632-7623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00233813AMedicaid
GA2200441OtherUNITED HEALTHCARE
GA9525135OtherCIGNA
GA553843OtherBLUECROSSBLUESHIELD
GA9525135OtherCIGNA
GA41ZCBSLMedicare PIN
GA1227940001Medicare NSC