Provider Demographics
NPI:1871649608
Name:QUIGLEY, DEBORA ROSE (MD)
Entity type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:ROSE
Last Name:QUIGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 HOSPITAL RD
Mailing Address - Street 2:STE A
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:178 HOSPITAL RD
Practice Address - Street 2:STE A
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3139
Practice Address - Country:US
Practice Address - Phone:706-745-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8906984Medicaid
GA00543243AMedicaid
GA10034339OtherAMERIGROUP
GA335900OtherWELLCARE
NC8906984Medicaid
GA08BDFWXMedicare ID - Type Unspecified