Provider Demographics
NPI:1558990911
Name:TELEMEDICINE ESSENTIALS OF AMERICA, LLC
Entity Type:Organization
Organization Name:TELEMEDICINE ESSENTIALS OF AMERICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUINTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-822-6019
Mailing Address - Street 1:2001 MONTREAL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5219
Mailing Address - Country:US
Mailing Address - Phone:404-822-6019
Mailing Address - Fax:888-470-1212
Practice Address - Street 1:2001 MONTREAL RD STE 105
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5219
Practice Address - Country:US
Practice Address - Phone:404-822-6019
Practice Address - Fax:888-470-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service