Healthcare Provider Details

I. General information

NPI: 1326903733
Provider Name (Legal Business Name): QUINCY METCALF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W MOCKINGBIRD LN
DALLAS TX
75247-5028
US

IV. Provider business mailing address

14838 MAGNOLIA LN
BALCH SPRINGS TX
75180-4354
US

V. Phone/Fax

Practice location:
  • Phone: 972-489-5552
  • Fax:
Mailing address:
  • Phone: 318-573-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number24372
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: