Provider Demographics
NPI:1801948369
Name:QUINTESSA MEDICAL INC.
Entity type:Organization
Organization Name:QUINTESSA MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAKOORA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMONUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-767-8884
Mailing Address - Street 1:4896 TREE TOPS DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2667
Mailing Address - Country:US
Mailing Address - Phone:404-767-8884
Mailing Address - Fax:404-767-8815
Practice Address - Street 1:777 CLEVELAND AVE SW STE 602
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7116
Practice Address - Country:US
Practice Address - Phone:404-767-8884
Practice Address - Fax:404-767-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037895261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service