Organization · NPI-2
Quality Health Source
Family Medicine · Mableton, GA
NPI number1780327346
StatusActive
Last updated in NPPESOct 4, 2024
Details
- NPI
- 1780327346
- Entity type
- Organization (NPI-2)
- Legal business name
- Quality Health Source
- Organization subpart
- No
- Enumeration date
- Apr 20, 2022
- Certification date
- Oct 4, 2024
- Last updated
- Oct 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | – | – | Yes |
| 164W00000X | Licensed Practical Nurse | – | – |
Practice location
6116 Mableton Pkwy Sw Ste 136Mableton, GA 30126-4305
Phone 770-878-2997
Mailing address
6116 Mableton Pkwy Sw Ste 136Mableton, GA 30126-4305
Phone 678-324-8009 · Fax 678-324-8017
Authorized official
Temeka L Johnson
NP
6783248009
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