Provider Demographics
NPI:1952628133
Name:QUINTERO, ELMER LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ELMER
Middle Name:LUIS
Last Name:QUINTERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9690 ROD RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7596
Mailing Address - Country:US
Mailing Address - Phone:470-228-1868
Mailing Address - Fax:
Practice Address - Street 1:3073 PANTHERSVILLE RD BLDG 3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3800
Practice Address - Country:US
Practice Address - Phone:404-243-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-27
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2709562084P0800X
FLME01427322084P0800X
GA858632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03967677Medicaid
NYJ400169835Medicare PIN