Provider Demographics
NPI:1174915102
Name:QUALLS, JAMES E III
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:QUALLS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 ASHLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7413
Mailing Address - Country:US
Mailing Address - Phone:937-360-6834
Mailing Address - Fax:
Practice Address - Street 1:4896 ASHLEIGH DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7413
Practice Address - Country:US
Practice Address - Phone:937-360-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH259975171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor