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General NPI Number Information
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NPI Number | 1396408084
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Entity Type | Organization
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Legal Business Name | QUANTUM PERSONAL HOME CARE
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 2775 CRUSE RD NW STE 201
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044
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Country | US
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Telephone | 678-353-8528
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Fax |
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Provider Business Mailing Address
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Address Line | 1398 CHRISTIANA DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-5210
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Country | US
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Telephone | 678-353-8528
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANITA PRINCE
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Credential | NP
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Telephone | 678-353-8528
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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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