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General NPI Number Information
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NPI Number | 1295602647
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Entity Type | Organization
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Legal Business Name | QUALITY CHRONIC CARE MANAGEMENT LLC
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2241 DAWN CT
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City | SUWANEE
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State | GA
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Zip | 30024-2732
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Country | US
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Telephone | 678-751-1776
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Fax | 888-220-6375
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Provider Business Mailing Address
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Address Line | 2241 DAWN CT
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City | SUWANEE
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State | GA
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Zip | 30024-2732
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Country | US
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Telephone | 678-751-1776
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Fax | 888-220-6375
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Authorized Official
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Title or Position | MEMBER
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Name | CHANTHYMA PHENGPHANH
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Credential | MS
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Telephone | 678-751-1776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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