Provider Demographics
NPI:1912407719
Name:QRC 360 ENTERPRISES
Entity Type:Organization
Organization Name:QRC 360 ENTERPRISES
Other - Org Name:MEDI-WEIGHTLOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:TSIROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-293-0173
Mailing Address - Street 1:720 QUAIL RUN CT
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8920
Mailing Address - Country:US
Mailing Address - Phone:404-293-0173
Mailing Address - Fax:888-657-0467
Practice Address - Street 1:12195 HIGHWAY 92 STE 144
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3603
Practice Address - Country:US
Practice Address - Phone:678-540-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30053207Q00000X
GA218918RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1184161622Medicaid
GA1265505531Medicaid