MEDICARE: QUALITY HEALTH SOURCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780327346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY HEALTH SOURCE

Provider Business Mailing Address
First Line	:	6116 MABLETON PKWY SW STE 136
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-4305
Country	:	US
Telephone Number	:	678-324-8009
Fax Number	:	678-324-8017

Provider Business Practice Location Address
First Line	:	6116 MABLETON PKWY SW STE 136
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-4305
Country	:	US
Telephone Number	:	770-878-2997
Fax Number	:

Authorized Official
Title or Position	:	NP
Name	:	TEMEKA L JOHNSON
Credential	:
Telephone Number	:	678-324-8009

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	10/04/2024

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Directions to “QUALITY HEALTH SOURCE ” Practice Location

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