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General NPI Number Information
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NPI Number | 1194597401
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Entity Type | Organization
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Legal Business Name | QUALITY CARE PCH, INC.
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 1371 KIMBERLY WAY SW
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City | ATLANTA
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State | GA
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Zip | 30331-4602
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Country | US
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Telephone | 404-587-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 2766 SPAIN DR
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City | EAST POINT
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State | GA
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Zip | 30344-3944
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Country | US
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Telephone | 404-587-1950
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. CHRISTOPHER PERDUE
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Credential | MR.
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Telephone | 404-587-1950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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