Provider Demographics
NPI:1457007858
Name:QUANTUM NATURAL HEALTH & WELLNESS CORP
Entity Type:Organization
Organization Name:QUANTUM NATURAL HEALTH & WELLNESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:III
Authorized Official - Credentials:ND
Authorized Official - Phone:855-764-4473
Mailing Address - Street 1:501 HIGHWAY 138 SW STE 6
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3905
Mailing Address - Country:US
Mailing Address - Phone:855-764-4473
Mailing Address - Fax:
Practice Address - Street 1:501 HIGHWAY 138 SW STE 6
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3905
Practice Address - Country:US
Practice Address - Phone:855-764-4473
Practice Address - Fax:678-261-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service