=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164295523
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUASAR FAMILY MEDICINE GEORGIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2023
-----------------------------------------------------
Last Update Date | 11/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 179 PINE GROVE RD
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120-8489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-935-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4850 TAMIAMI TRL N UNIT 301
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-935-5721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SEAN ALEXANDER FEINBERG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-935-5721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------