Provider Demographics
NPI:1205903747
Name:QUAO, NII SABAN (MD, PC)
Entity type:Individual
Prefix:
First Name:NII
Middle Name:SABAN
Last Name:QUAO
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ENON SPRINGS RD E
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4446
Mailing Address - Country:US
Mailing Address - Phone:615-355-1994
Mailing Address - Fax:615-355-1846
Practice Address - Street 1:519 ENON SPRINGS RD E
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4446
Practice Address - Country:US
Practice Address - Phone:615-355-1994
Practice Address - Fax:615-355-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621131838OtherTAX IDENTIFICATION NUMBER
TN3184831Medicaid
TN3184831Medicaid
TN3184831Medicare PIN