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General NPI Number Information
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NPI Number | 1205585601
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Entity Type | Organization
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Legal Business Name | QUICKMD MEDICAL GROUP PA
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Dates
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Enumeration Date | 03/22/2022
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 1251 STAFFORD ST UNIT 6
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City | MONROE
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State | NC
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Zip | 28110-3349
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Country | US
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Telephone | 888-878-4256
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Fax |
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Provider Business Mailing Address
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Address Line | 3865 HOLCOMB BRIDGE RD
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-2205
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Country | US
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Telephone | 888-878-4256
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Fax |
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Authorized Official
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Title or Position | SENIOR MANAGER, CREDENTIALING
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Name | KATRINA MERRITT
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Credential |
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Telephone | 813-596-5726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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