Provider Demographics
NPI:1447350483
Name:QUINN, TIMOTHY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:QUINN
Suffix:
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:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39158-0750
Mailing Address - Country:US
Mailing Address - Phone:601-899-3990
Mailing Address - Fax:
Practice Address - Street 1:768 AVERY BLVD N
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5219
Practice Address - Country:US
Practice Address - Phone:601-487-6482
Practice Address - Fax:601-487-6528
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
51466372OtherUNITED HEALTHCARE
MS510466372OtherMS HEALTH PARTNERS
0007359513OtherAETNA
51046637239211A001OtherTRICARE
5104663720001OtherCIGNA
P00072227OtherMEDICARE RAILROAD MS
MS03620330Medicaid
510466732OtherFIRST CHOICE
P00072227OtherMEDICARE RAILROAD MS
MS03620330Medicaid