Healthcare Provider Details

I. General information

NPI: 1205585601
Provider Name (Legal Business Name): QUICKMD MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 STAFFORD ST UNIT 6
MONROE NC
28110-3349
US

IV. Provider business mailing address

3865 HOLCOMB BRIDGE RD
PEACHTREE CORNERS GA
30092-2205
US

V. Phone/Fax

Practice location:
  • Phone: 888-878-4256
  • Fax:
Mailing address:
  • Phone: 888-878-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATRINA MERRITT
Title or Position: SENIOR MANAGER, CREDENTIALING
Credential:
Phone: 813-596-5726