Provider Demographics
NPI:1568125524
Name:QUALIFIED QUACKS
Entity Type:Organization
Organization Name:QUALIFIED QUACKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:BOTOS
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:770-750-5099
Mailing Address - Street 1:1545 RAINIER FALLS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4105
Mailing Address - Country:US
Mailing Address - Phone:404-719-6746
Mailing Address - Fax:
Practice Address - Street 1:1545 RAINIER FALLS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4105
Practice Address - Country:US
Practice Address - Phone:404-719-6746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care