Individual
MRS. BENITA K QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1407 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Mailing address
1407 W BADDOUR PKWY, LEBANON, TN 37087-2513
(615) 444-6203
(615) 444-6252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
185
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1523861
—
TN
01
—
185
PHYSICIAN ASSISTANT LICENSE
TN
01
—
3323092
UHC
TN
01
—
4298144
BCBS
TN
Enumeration date
05/09/2008
Last updated
08/09/2011
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