Provider Demographics
NPI:1952677015
Name:GRANT, QUINTESIA L (MD/PHD)
Entity Type:Individual
Prefix:
First Name:QUINTESIA
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 HOSPITAL WEST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8117
Mailing Address - Country:US
Mailing Address - Phone:770-793-7899
Mailing Address - Fax:770-793-7856
Practice Address - Street 1:4040 HOSPITAL WEST DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8117
Practice Address - Country:US
Practice Address - Phone:770-793-7899
Practice Address - Fax:770-793-7856
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 34140207R00000X
NMMD2024-0008207RH0002X
GA076563207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine