Provider Demographics
NPI:1932894003
Name:MEDQUEEN MEDICAL LLC
Entity Type:Organization
Organization Name:MEDQUEEN MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-714-1380
Mailing Address - Street 1:4550 JONESBORO RD STE 2A #241
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2053
Mailing Address - Country:US
Mailing Address - Phone:202-714-1380
Mailing Address - Fax:
Practice Address - Street 1:2730 ROCKY CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8484
Practice Address - Country:US
Practice Address - Phone:202-714-1380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty