Provider Demographics
NPI:1295063808
Name:MICHAEL A. QUINONES, MD, PC
Entity type:Organization
Organization Name:MICHAEL A. QUINONES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-501-9170
Mailing Address - Street 1:2675 N DECATUR RD
Mailing Address - Street 2:SUITE 609
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6131
Mailing Address - Country:US
Mailing Address - Phone:404-501-9170
Mailing Address - Fax:404-974-2699
Practice Address - Street 1:5730 GLENRIDGE DR STE 310
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5561
Practice Address - Country:US
Practice Address - Phone:404-501-9170
Practice Address - Fax:404-974-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000626029IMedicaid
E36866Medicare UPIN