Healthcare Provider Details

I. General information

NPI: 1205031291
Provider Name (Legal Business Name): QUANTUM HEALTHWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 COLONY PARK DR SUITE 800
CUMMING GA
30040-2792
US

IV. Provider business mailing address

104 COLONY PARK DR SUITE 800
CUMMING GA
30040-2792
US

V. Phone/Fax

Practice location:
  • Phone: 678-947-4454
  • Fax: 678-208-9876
Mailing address:
  • Phone: 678-947-4454
  • Fax: 678-208-9876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number012495
License Number StateGA

VIII. Authorized Official

Name: MRS. STACIE SLOAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 678-947-4454