Healthcare Provider Details

I. General information

NPI: 1942857297
Provider Name (Legal Business Name): QUIET HEARTBEAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 KING ARTHURS WAY APT 203
FREDERICKSBURG VA
22406-6421
US

IV. Provider business mailing address

101 KING ARTHURS WAY APT 203
FREDERICKSBURG VA
22406-6421
US

V. Phone/Fax

Practice location:
  • Phone: 540-219-3895
  • Fax:
Mailing address:
  • Phone: 540-219-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVAUGHN D JOHNSON
Title or Position: CHIEF OPRATIONS OFFICER
Credential:
Phone: 540-219-3895