Individual
SHARLENE R QUARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
005783
GA
363AS0400X
Surgical Physician Assistant
Primary
P54368
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003133456A
—
GA
05
—
003133456B
—
GA
05
—
003133456C
—
GA
01
—
P54368
NYS LICENSE
NY
01
—
PA LICENSE 5783
GEORGIA COMPOSITE STATE BOARD
GA
Enumeration date
05/02/2007
Last updated
05/10/2019
Update your record
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