Provider Demographics
NPI:1124613815
Name:QUALITY PRIMARY CARE
Entity type:Organization
Organization Name:QUALITY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:706-534-4637
Mailing Address - Street 1:1175 MITCHELL BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1175 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6411
Practice Address - Country:US
Practice Address - Phone:706-534-4637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190555HMedicaid