Provider Demographics
NPI:1083186738
Name:QUIROZ, MISTY LEIGH
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEIGH
Last Name:QUIROZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 ATLANTA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2192
Mailing Address - Country:US
Mailing Address - Phone:678-503-2474
Mailing Address - Fax:
Practice Address - Street 1:97 ATLANTA ST STE 100
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2192
Practice Address - Country:US
Practice Address - Phone:678-503-2474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst