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General NPI Number Information
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NPI Number | 1952628133
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Entity Type | Individual
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Provider Name | ELMER LUIS QUINTERO M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 3073 PANTHERSVILLE RD BLDG 3
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City | DECATUR
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State | GA
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Zip | 30034-3800
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Country | US
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Telephone | 404-243-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 9690 ROD RD
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City | JOHNS CREEK
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State | GA
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Zip | 30022-7596
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Country | US
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Telephone | 470-228-1868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 270956
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME0142732
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 85863
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License Number State | GA
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