Basic Information
| Provider Information | |||||||||
| NPI: | 1487162616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCQUITTY | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | NELL | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4648 HICKORY CREEK CIR | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316024935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292441400 | ||||||||
| FaxNumber: | 2292445512 | ||||||||
| Practice Location | |||||||||
| Address1: | 2412 N OAK ST | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316022567 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2292441400 | ||||||||
| FaxNumber: | 2292445512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN138410 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.