Healthcare Provider Details

I. General information

NPI: 1861309411
Provider Name (Legal Business Name): JADEN QUANDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6378 WEDGEVIEW DR
TUCKER GA
30084-8763
US

IV. Provider business mailing address

6378 WEDGEVIEW DR
TUCKER GA
30084-8763
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-3006
  • Fax:
Mailing address:
  • Phone: 678-687-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: