Healthcare Provider Details

I. General information

NPI: 1912407719
Provider Name (Legal Business Name): QRC 360 ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12195 HIGHWAY 92 STE 144
WOODSTOCK GA
30188-3603
US

IV. Provider business mailing address

720 QUAIL RUN CT
JOHNS CREEK GA
30005-8920
US

V. Phone/Fax

Practice location:
  • Phone: 678-540-7827
  • Fax:
Mailing address:
  • Phone: 404-293-0173
  • Fax: 888-657-0467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218918RN
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30053
License Number StateGA

VIII. Authorized Official

Name: MR. ARTHUR TSIROPOULOS
Title or Position: PRESIDENT & CEO
Credential:
Phone: 404-293-0173