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General NPI Number Information
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NPI Number | 1093137457
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Entity Type | Organization
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Legal Business Name | QUEST ACTIVE CARE, LLC.
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 01/20/2014
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Provider Practice Location Address
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Address Line | 8470 HOLCOMB BRIDGE RD SUITE 140
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City | ALPHARETTA
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State | GA
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Zip | 30022-1854
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Country | US
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Telephone | 678-461-9337
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Fax | 678-461-9338
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Provider Business Mailing Address
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Address Line | 8470 HOLCOMB BRIDGE RD SUITE 140
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City | ALPHARETTA
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State | GA
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Zip | 30022-1854
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Country | US
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Telephone | 678-461-9337
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Fax | 678-461-9338
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Authorized Official
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Title or Position | PRESIDENT- OWNER
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Name | MR. KAMRAN AYAGH
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Credential |
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Telephone | 678-461-9337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | GA
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