Provider Demographics
NPI:1356792501
Name:SONQUEST DEVELOPMENT, INC.
Entity type:Organization
Organization Name:SONQUEST DEVELOPMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:813-546-8815
Mailing Address - Street 1:2107 N DECATUR RD STE 738
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:813-546-8815
Mailing Address - Fax:
Practice Address - Street 1:2796 HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2735
Practice Address - Country:US
Practice Address - Phone:678-374-5134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service