Healthcare Provider Details

I. General information

NPI: 1356852123
Provider Name (Legal Business Name): QSM-GA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 WHITING ST NW
ATLANTA GA
30318-4563
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 800-226-8874
  • Fax: 305-466-9989
Mailing address:
  • Phone: 305-466-9988
  • Fax: 305-466-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MAGILEN
Title or Position: CEO/OWNER
Credential: MD
Phone: 305-466-9988