Provider Demographics
NPI:1780327346
Name:QUALITY HEALTH SOURCE
Entity type:Organization
Organization Name:QUALITY HEALTH SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:TEMEKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-324-8009
Mailing Address - Street 1:6116 MABLETON PKWY SW STE 136
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-4305
Mailing Address - Country:US
Mailing Address - Phone:678-324-8009
Mailing Address - Fax:678-324-8017
Practice Address - Street 1:6116 MABLETON PKWY SW STE 136
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-4305
Practice Address - Country:US
Practice Address - Phone:770-878-2997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty